MEDICARE: DAMON CHRISTOPHER DEWEESE D.C.

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	CH8089	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00001614	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1710956669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON CHRISTOPHER DEWEESE D.C.

Provider Business Mailing Address
First Line	:	1312 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4836
Country	:	US
Telephone Number	:	904-757-4786
Fax Number	:	904-757-4882

Provider Business Practice Location Address
First Line	:	1312 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4836
Country	:	US
Telephone Number	:	904-757-4786
Fax Number	:	904-757-4882

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/09/2007

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