MEDICARE: GAINESVILLE CHIROPRACTIC, INC

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	CH8427	FL

General Provider Information

NPI Number	:	1750662524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAINESVILLE CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	5200 NW 43RD ST
Second Line	:	SUITE 507
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4484
Country	:	US
Telephone Number	:	352-264-0314
Fax Number	:	352-264-0315

Provider Business Practice Location Address
First Line	:	5200 NW 43RD ST
Second Line	:	SUITE 507
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4484
Country	:	US
Telephone Number	:	352-264-0314
Fax Number	:	352-264-0315

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. WALTER C MCCANTS
Credential	:
Telephone Number	:	352-264-0314

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	12/12/2011

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