MEDICARE: RISE CHIROPRACTIC

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	261QH0100X	Health Service Clinic/Center	CH11998	FL

General Provider Information

NPI Number	:	1770071011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	348 MIRACLE STRIP PKWY SW STE 20
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5263
Country	:	US
Telephone Number	:	574-229-4177
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 MIRACLE STRIP PKWY SW STE 20
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5263
Country	:	US
Telephone Number	:	574-229-4177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIZABETH SNOW
Credential	:	DC
Telephone Number	:	574-229-4177

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	04/23/2018

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Directions to “RISE CHIROPRACTIC ” Practice Location

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