MEDICARE: ALTOMARE CHIROPRACTIC CENTER PA

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	CH4855	FL

General Provider Information

NPI Number	:	1720138035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTOMARE CHIROPRACTIC CENTER PA

Provider Business Mailing Address
First Line	:	10175 FORTUNE PKWY
Second Line	:	STE 1001
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6746
Country	:	US
Telephone Number	:	904-464-0319
Fax Number	:	904-464-0672

Provider Business Practice Location Address
First Line	:	10175 FORTUNE PKWY
Second Line	:	SUITE 1001
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6746
Country	:	US
Telephone Number	:	904-464-0319
Fax Number	:	904-464-0672

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH J ALTOMARE
Credential	:	DC
Telephone Number	:	904-464-0319

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/04/2008

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