MEDICARE: DR. ELENA M MORREALE 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	CH 7443	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55656	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1740310655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENA M MORREALE D.C.

Provider Business Mailing Address
First Line	:	10031 N DALE MABRY HWY
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33618-4409
Country	:	US
Telephone Number	:	813-968-5404
Fax Number	:	813-968-5451

Provider Business Practice Location Address
First Line	:	10031 N DALE MABRY HWY
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33618-4409
Country	:	US
Telephone Number	:	813-968-5404
Fax Number	:	813-968-5451

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

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

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