MEDICARE: CHIROPRACTIC FIRST LIFE

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	CH0006836	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55284	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1801827472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC FIRST LIFE

Provider Business Mailing Address
First Line	:	8600 W STATE ROAD 84 STE C
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-424-1142
Fax Number	:	954-424-1143

Provider Business Practice Location Address
First Line	:	8600 W STATE ROAD 84 STE C
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-424-1142
Fax Number	:	954-424-1143

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGG L WESSLER
Credential	:	DC
Telephone Number	:	954-424-1142

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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Directions to “CHIROPRACTIC FIRST LIFE ” Practice Location

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