MEDICARE: PANAMA CITY BEACH MEDICAL SOLUTIONS

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

General Provider Information

NPI Number	:	1730712076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANAMA CITY BEACH MEDICAL SOLUTIONS

Provider Business Mailing Address
First Line	:	9044 SE BRIDGE RD
Second Line	:
City	:	HOBE SOUND
State	:	FL
Zip	:	33455-5313
Country	:	US
Telephone Number	:	772-546-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2168
Country	:	US
Telephone Number	:	772-546-9591
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENEANE M WAKULA
Credential	:
Telephone Number	:	772-546-9591

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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