MEDICARE: CHIRO-MED HEALTH AND REHAB PL

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	CH8838	FL

General Provider Information

NPI Number	:	1447446828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO-MED HEALTH AND REHAB PL

Provider Business Mailing Address
First Line	:	12479 S ACCESS RD
Second Line	:	SUITE 1
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-6206
Country	:	US
Telephone Number	:	941-697-3001
Fax Number	:	941-697-3003

Provider Business Practice Location Address
First Line	:	12479 S ACCESS RD
Second Line	:	SUITE 1
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-6206
Country	:	US
Telephone Number	:	941-697-3001
Fax Number	:	941-697-3003

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. KRISTIN NOEL JOSEPH
Credential	:	DC
Telephone Number	:	941-697-3001

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	03/18/2013

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