MEDICARE: DR. STEWART G GORENBERG D.C.

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	3282	FL

General Provider Information

NPI Number	:	1407969512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEWART G GORENBERG D.C.

Provider Business Mailing Address
First Line	:	1627 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-522-6000
Fax Number	:	954-522-6073

Provider Business Practice Location Address
First Line	:	1627 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-522-6000
Fax Number	:	954-522-6073

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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