MEDICARE: TIMOTHY J. O'GRADY CHIROPRACTIC

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	CH005451	FL

General Provider Information

NPI Number	:	1689830903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY J. O'GRADY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2708 SOUTH U.S. ONE
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-468-1000
Fax Number	:	772-468-1025

Provider Business Practice Location Address
First Line	:	2708 SOUTH U.S. ONE
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-468-1000
Fax Number	:	772-468-1025

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY J. O'GRADY
Credential	:	D.C
Telephone Number	:	772-468-1000

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	08/06/2008

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