MEDICARE: DR. JEFFREY S. TARTACK 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	CH0008769	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	:	1457423741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY S. TARTACK DC

Provider Business Mailing Address
First Line	:	1222 S ANDREWS AVE
Second Line	:	SUITE 501
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1806
Country	:	US
Telephone Number	:	954-764-4042
Fax Number	:	954-764-7275

Provider Business Practice Location Address
First Line	:	1222 S ANDREWS AVE
Second Line	:	SUITE 501
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1806
Country	:	US
Telephone Number	:	954-764-4042
Fax Number	:	954-764-7275

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/08/2014

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