MEDICARE: JOSEPH ADAM MULLANACK

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	CH9193	FL

General Provider Information

NPI Number	:	1508883513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ADAM MULLANACK

Provider Business Mailing Address
First Line	:	1406 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4706
Country	:	US
Telephone Number	:	772-584-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4706
Country	:	US
Telephone Number	:	772-464-3831
Fax Number	:	772-468-8921

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	02/21/2018

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Directions to “ JOSEPH ADAM MULLANACK ” Practice Location

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