MEDICARE: MARCUS CHIROPRACTIC CENTER, INC

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	CH7508	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699043851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCUS CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	2710 E. OAKLAND PARK BLVD.
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33306
Country	:	US
Telephone Number	:	954-575-1175
Fax Number	:	954-566-0361

Provider Business Practice Location Address
First Line	:	2710 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1605
Country	:	US
Telephone Number	:	954-575-1175
Fax Number	:	954-566-0361

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. PETER J. MARCUS
Credential	:	DC
Telephone Number	:	954-575-1175

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	09/07/2012

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