MEDICARE: CHIROMEDIC SERVICES OF N.M.B, 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	111NR0400X	Rehabilitation Chiropractor	CH9004	FL

General Provider Information

NPI Number	:	1710259247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROMEDIC SERVICES OF N.M.B, INC

Provider Business Mailing Address
First Line	:	16932 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3110
Country	:	US
Telephone Number	:	786-201-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	16932 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3110
Country	:	US
Telephone Number	:	786-201-2778
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. PAUL L GUADAGNO
Credential	:	DC
Telephone Number	:	786-657-3242

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	02/29/2012

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