MEDICARE: JASON P HURLEY DC, 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	111N00000X	Chiropractor	CH9953	FL

General Provider Information

NPI Number	:	1770846420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON P HURLEY DC, LLC

Provider Business Mailing Address
First Line	:	3687 TAMPA RD
Second Line	:	202
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3687 TAMPA RD
Second Line	:	202
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6307
Country	:	US
Telephone Number	:	813-393-6578
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON PAUL HURLEY
Credential	:	DC
Telephone Number	:	813-393-6578

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	08/29/2012

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