MEDICARE: DR. DEBORA LYNN PORTER 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	CH10961	FL

General Provider Information

NPI Number	:	1508299488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORA LYNN PORTER D.C.

Provider Business Mailing Address
First Line	:	5111 S RIDGEWOOD AVE
Second Line	:	SUITE 103
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5169
Country	:	US
Telephone Number	:	386-310-8766
Fax Number	:	386-310-8770

Provider Business Practice Location Address
First Line	:	1367 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-173-2000
Fax Number	:	386-265-5552

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	05/05/2020

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