MEDICARE: NATHANSON CHIROPRACTIC PA

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	CH0001974	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89368	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508896531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHANSON CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	409 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-582-5433
Fax Number	:	561-585-0074

Provider Business Practice Location Address
First Line	:	409 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-582-5433
Fax Number	:	561-585-0074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL E NATHANSON
Credential	:	DC
Telephone Number	:	561-582-5433

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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