MEDICARE: OVERLEA-FULLERTON CHIROPRACTIC CENTER PC

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	CH006174	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	271773	OTHER	FL	WELLCARE PRVD#
2	89273	OTHER	FL	BCBS PRVD#
3	295986	OTHER	FL	AVMED PRVD#
4	593466707	OTHER	FL	CHIRO ALLIANCE #
5	CH006174	OTHER	FL	STATE LICENSE #
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780801761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERLEA-FULLERTON CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	5317 VILLAGE MARKET DRIVE
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544
Country	:	US
Telephone Number	:	813-994-6008
Fax Number	:	813-994-3063

Provider Business Practice Location Address
First Line	:	5317 VILLAGE MARKET DRIVE
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544
Country	:	US
Telephone Number	:	813-994-6008
Fax Number	:	813-994-3063

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	BRIAN J AUGUSTINE
Credential	:
Telephone Number	:	813-994-6008

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	10/20/2010

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Directions to “OVERLEA-FULLERTON CHIROPRACTIC CENTER PC ” Practice Location

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