MEDICARE: AMARA CHIROPRACTIC CENTER

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	CH3216	FL

General Provider Information

NPI Number	:	1689119125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARA CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	2445 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3077
Country	:	US
Telephone Number	:	386-767-2064
Fax Number	:	386-756-5700

Provider Business Practice Location Address
First Line	:	2445 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3077
Country	:	US
Telephone Number	:	386-767-2064
Fax Number	:	386-756-5700

Authorized Official
Title or Position	:	CHRIOPRACTOR
Name	:	DR. ROBERT JOHN AMARA JR.
Credential	:	D.C.
Telephone Number	:	386-767-2064

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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