MEDICARE: DR. WILLIAM JACK GARRISON 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	CH9353	FL

General Provider Information

NPI Number	:	1609079169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JACK GARRISON D.C.

Provider Business Mailing Address
First Line	:	3528 FOREST BRANCH DR APT D
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-8957
Country	:	US
Telephone Number	:	813-716-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 W BAKER ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4309
Country	:	US
Telephone Number	:	813-754-2273
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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