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NPI Code Detail

MEDICARE: DR. GREGORY JOSEPH BOOTH DC

MEDICARE: DR. GREGORY JOSEPH BOOTH DC
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
1111N00000XChiropractor15074FL

General Provider Information

NPI Number : 1811735806
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY JOSEPH BOOTH DC
Provider Business Mailing Address
First Line : 110 N KIRKMAN RD
Second Line :
City : ORLANDO
State : FL
Zip : 32811-1404
Country : US
Telephone Number : 407-291-1000
Fax Number :
Provider Business Practice Location Address
First Line : 110 N KIRKMAN RD
Second Line :
City : ORLANDO
State : FL
Zip : 32811-1404
Country : US
Telephone Number : 407-291-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2024
Last Update Date : 09/10/2024

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