MEDICARE: HANNAH GOMOLAK DC

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	CH15216	FL

General Provider Information

NPI Number	:	1750107256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH GOMOLAK DC

Provider Business Mailing Address
First Line	:	3510 S NOVA RD STE 111
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3796
Country	:	US
Telephone Number	:	386-947-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S NOVA RD STE 111
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3796
Country	:	US
Telephone Number	:	386-947-7185
Fax Number	:

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

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	11/29/2024

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Directions to “ HANNAH GOMOLAK DC” Practice Location

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