MEDICARE: SAN CARLOS CHIROPRACTIC 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	CH0004195	FL

General Provider Information

NPI Number	:	1447363882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN CARLOS CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	19150 ACORN ROAD
Second Line	:	SUITE 103
City	:	FORT MYERS
State	:	FL
Zip	:	33967-3657
Country	:	US
Telephone Number	:	239-267-3133
Fax Number	:	239-267-8032

Provider Business Practice Location Address
First Line	:	19150 ACORN ROAD
Second Line	:	SUITE 103
City	:	FORT MYERS
State	:	FL
Zip	:	33967-3657
Country	:	US
Telephone Number	:	239-267-3133
Fax Number	:	239-267-8032

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. GLEN SCHAFFER
Credential	:	DC
Telephone Number	:	239-267-3133

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	04/01/2008

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