MEDICARE: DR. JUAN PABLO AHUMADA 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	CH13201	FL

General Provider Information

NPI Number	:	1407446040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN PABLO AHUMADA DC

Provider Business Mailing Address
First Line	:	727 BAY ST
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-5008
Country	:	US
Telephone Number	:	213-858-1488
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	727-610-6324
Fax Number	:

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

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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