MEDICARE: FLORIDA CHIROPRACTIC HEALTH CENTER, LLC

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	CH 9040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	64003	OTHER	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NPI	OTHER	1629122379

General Provider Information

NPI Number	:	1568649614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA CHIROPRACTIC HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	7806 LAKE UNDERHILL RD
Second Line	:	SUITE 104
City	:	ORLANDO
State	:	FL
Zip	:	32822-8232
Country	:	US
Telephone Number	:	407-730-9311
Fax Number	:	407-730-9310

Provider Business Practice Location Address
First Line	:	7806 LAKE UNDERHILL RD
Second Line	:	SUITE 104
City	:	ORLANDO
State	:	FL
Zip	:	32822-8232
Country	:	US
Telephone Number	:	407-730-9311
Fax Number	:	407-730-9310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDUARDO TOBENAS
Credential	:	D.C.
Telephone Number	:	407-774-6800

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	12/31/2014

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Directions to “FLORIDA CHIROPRACTIC HEALTH CENTER, LLC ” Practice Location

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