MEDICARE: INTERNATIONAL CHIROPRACTIC CENTER, LLC

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	CH5869	FL

General Provider Information

NPI Number	:	1841347689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	5030 DR PHILLIPS BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-3310
Country	:	US
Telephone Number	:	407-291-2889
Fax Number	:	407-291-2994

Provider Business Practice Location Address
First Line	:	5030 DR PHILLIPS BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-3310
Country	:	US
Telephone Number	:	407-291-2889
Fax Number	:	407-291-2994

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. STEVEN K. NEWTON
Credential	:	D.C.
Telephone Number	:	407-291-2889

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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