MEDICARE: DR. RICHARD G PACKO 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	CH0006259	FL

General Provider Information

NPI Number	:	1720057086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD G PACKO DC

Provider Business Mailing Address
First Line	:	252 SOLANA RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2297
Country	:	US
Telephone Number	:	904-285-2243
Fax Number	:	904-285-9022

Provider Business Practice Location Address
First Line	:	252 SOLANA RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2297
Country	:	US
Telephone Number	:	904-285-2243
Fax Number	:	904-285-9022

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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