MEDICARE: DR. ANTONIO COFFA

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	CH13909	FL

General Provider Information

NPI Number	:	1710639141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO COFFA

Provider Business Mailing Address
First Line	:	5348 COQUINA SHORES LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3009
Country	:	US
Telephone Number	:	416-272-2407
Fax Number	:

Provider Business Practice Location Address
First Line	:	5348 COQUINA SHORES LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3009
Country	:	US
Telephone Number	:	416-272-2407
Fax Number	:

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “ DR. ANTONIO COFFA ” Practice Location

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