MEDICARE: MAURICIO CHIROPRACTIC MELBOURNE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1376056291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICIO CHIROPRACTIC MELBOURNE LLC

Provider Business Mailing Address
First Line	:	12278 E COLONIAL DR STE 600H
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4724
Country	:	US
Telephone Number	:	407-381-0878
Fax Number	:	407-373-6046

Provider Business Practice Location Address
First Line	:	187 S WICKHAM RD STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-372-5033
Fax Number	:	321-372-5034

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD S BIRD
Credential	:	D.C.
Telephone Number	:	407-381-0878

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	10/19/2018

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