MEDICARE: EDNER THEODORE D.O.

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	111NR0400X	Rehabilitation Chiropractor	CH8072	FL

General Provider Information

NPI Number	:	1649308180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNER THEODORE D.O.

Provider Business Mailing Address
First Line	:	4760 S. ORANGE BLOSSOM TRL.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1706
Country	:	US
Telephone Number	:	407-851-8810
Fax Number	:	407-851-9910

Provider Business Practice Location Address
First Line	:	4670 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1706
Country	:	US
Telephone Number	:	407-851-8810
Fax Number	:	407-851-9910

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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Directions to “ EDNER THEODORE D.O.” Practice Location

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