MEDICARE: DR. KUMPOL MANASVIGANGKUL 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	CH10581	FL

General Provider Information

NPI Number	:	1518231398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KUMPOL MANASVIGANGKUL D.C.

Provider Business Mailing Address
First Line	:	2415 S VOLUSIA AVE STE A2
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7623
Country	:	US
Telephone Number	:	386-882-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 S VOLUSIA AVE STE A2
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7623
Country	:	US
Telephone Number	:	386-882-8859
Fax Number	:

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

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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