MEDICARE: ST. LUCIE INJURY AND HEALTH, LLC

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	261Q00000X	Clinic/Center
2	111NR0400X	Rehabilitation Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8754334744	OTHER		DOT ME#

General Provider Information

NPI Number	:	1770096653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUCIE INJURY AND HEALTH, LLC

Provider Business Mailing Address
First Line	:	4842 N KINGS HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2243
Country	:	US
Telephone Number	:	772-882-0701
Fax Number	:	888-920-1114

Provider Business Practice Location Address
First Line	:	4842 N KINGS HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2243
Country	:	US
Telephone Number	:	772-882-0701
Fax Number	:	888-920-1114

Authorized Official
Title or Position	:	CEO
Name	:	DR. SUSAN PARKER SANDERS
Credential	:	DC
Telephone Number	:	772-882-0701

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	01/04/2021

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