MEDICARE: SEAN MATTHEW KIRKPATRICK DC

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	CH 7192	FL

General Provider Information

NPI Number	:	1710374483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MATTHEW KIRKPATRICK DC

Provider Business Mailing Address
First Line	:	2642 NEWTON AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5831
Country	:	US
Telephone Number	:	239-334-7558
Fax Number	:	239-334-7558

Provider Business Practice Location Address
First Line	:	2642 NEWTON AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5831
Country	:	US
Telephone Number	:	239-334-7558
Fax Number	:	239-334-7558

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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