MEDICARE: DR. RICHARD F SOBONA JR. DC

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	13745	FL

General Provider Information

NPI Number	:	1386306140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD F SOBONA JR. DC

Provider Business Mailing Address
First Line	:	1025 EAGLE LAKE TRL APT 303
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4192
Country	:	US
Telephone Number	:	412-974-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 EAGLE LAKE TRL APT 303
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4192
Country	:	US
Telephone Number	:	412-974-7863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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