MEDICARE: DR. LARE ZIEMBA 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	CHOOO6248	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588671192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARE ZIEMBA D.C.

Provider Business Mailing Address
First Line	:	433 NW PRIMA VISTA BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-8731
Country	:	US
Telephone Number	:	772-337-3141
Fax Number	:	772-336-1160

Provider Business Practice Location Address
First Line	:	433 NW PRIMA VISTA BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-8731
Country	:	US
Telephone Number	:	772-337-3141
Fax Number	:	772-336-1160

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/18/2009

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