MEDICARE: DR. JOHN WESLEY HOUSE 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	1286	LA
2	111N00000X	Chiropractor	8956	TX
3	111N00000X	Chiropractor	CH9357	FL

General Provider Information

NPI Number	:	1487623054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WESLEY HOUSE D.C.

Provider Business Mailing Address
First Line	:	1089 HOWELL CREEK DR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708
Country	:	US
Telephone Number	:	407-494-0899
Fax Number	:

Provider Business Practice Location Address
First Line	:	5685 RED BUG LAKE RD
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	321-274-1316
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/20/2023

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