MEDICARE: DR. RONALD M REPICE II 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	111NN0400X	Neurology Chiropractor	CH8620	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K8856	OTHER	FL	MEDICARE GROUP NUMBER
2	89613B	OTHER	FL	MEDICARE ID NUMBER

General Provider Information

NPI Number	:	1609873157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD M REPICE II D.C.

Provider Business Mailing Address
First Line	:	1715 HERITAGE TRL
Second Line	:	STE 203
City	:	NAPLES
State	:	FL
Zip	:	34112-8715
Country	:	US
Telephone Number	:	239-530-3040
Fax Number	:	239-530-3050

Provider Business Practice Location Address
First Line	:	1715 HERITAGE TRL
Second Line	:	STE 203
City	:	NAPLES
State	:	FL
Zip	:	34112-8715
Country	:	US
Telephone Number	:	239-530-3040
Fax Number	:	239-530-3050

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/09/2008

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