MEDICARE: OSLY PHILISTIN 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	CH9111	FL

General Provider Information

NPI Number	:	1518034172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSLY PHILISTIN D.C.

Provider Business Mailing Address
First Line	:	1712 ANNANDALE CIR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6103
Country	:	US
Telephone Number	:	561-271-6061
Fax Number	:	561-899-3180

Provider Business Practice Location Address
First Line	:	1962 S CONGRESS AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6674
Country	:	US
Telephone Number	:	561-819-6500
Fax Number	:	516-819-6502

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/02/2011

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