MEDICARE: DR. JAMES W DEGRACE 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	111NR0400X	Rehabilitation Chiropractor	CH5472	FL

General Provider Information

NPI Number	:	1750438180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W DEGRACE D.C.

Provider Business Mailing Address
First Line	:	5300 MAIN ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2509
Country	:	US
Telephone Number	:	727-841-9908
Fax Number	:	727-842-6270

Provider Business Practice Location Address
First Line	:	5300 MAIN ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2509
Country	:	US
Telephone Number	:	727-841-9908
Fax Number	:	727-842-6270

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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