MEDICARE: DR. JON STEVEN SAMPLES 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	CH6520	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730192774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON STEVEN SAMPLES D.C.

Provider Business Mailing Address
First Line	:	622 E 3RD AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3164
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 3RD AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3164
Country	:	US
Telephone Number	:	386-428-9327
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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