MEDICARE: GENTLE CHIROPRACTIC OFFICES, INC.

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	CH5283	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427382936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE CHIROPRACTIC OFFICES, INC.

Provider Business Mailing Address
First Line	:	1696 SE HILLMOOR DR
Second Line	:	SUITE C
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-335-3222
Fax Number	:	772-335-3793

Provider Business Practice Location Address
First Line	:	1696 SE HILLMOOR DR
Second Line	:	SUITE C
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-335-3222
Fax Number	:	772-335-3793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARRIS GOLDBERG
Credential	:	DC
Telephone Number	:	772-335-3222

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	11/06/2009

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Directions to “GENTLE CHIROPRACTIC OFFICES, INC. ” Practice Location

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