MEDICARE: ISLAND CHIROPRACTIC CENTER

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	CH9501	FL

General Provider Information

NPI Number	:	1780164947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	6500 LEONARD LN
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-1334
Country	:	US
Telephone Number	:	321-439-7265
Fax Number	:

Provider Business Practice Location Address
First Line	:	6295 TEAL LN
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2207
Country	:	US
Telephone Number	:	321-439-7265
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODEN C STEWART
Credential	:	DC
Telephone Number	:	321-439-7265

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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Directions to “ISLAND CHIROPRACTIC CENTER ” Practice Location

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