MEDICARE: DR. ANDREW OTTAVIANI 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	CH9370	FL

General Provider Information

NPI Number	:	1730385972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW OTTAVIANI D.C.

Provider Business Mailing Address
First Line	:	1784 ARASH CIR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7301
Country	:	US
Telephone Number	:	386-871-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 HERBERT ST
Second Line	:	SUITE 209
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6104
Country	:	US
Telephone Number	:	386-871-0153
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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