MEDICARE: DR. KENN ALLAN NIEBRUGGE D.C.

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	111NI0900X	Internist Chiropractor	CH8610	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831285360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENN ALLAN NIEBRUGGE D.C.

Provider Business Mailing Address
First Line	:	139 HOLDERRNESS DRIVE
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779
Country	:	US
Telephone Number	:	407-682-5243
Fax Number	:	407-682-5243

Provider Business Practice Location Address
First Line	:	4170 TOWN CENTER BLVD
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32837-5873
Country	:	US
Telephone Number	:	407-857-6166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/24/2008

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