MEDICARE: JERROD PRESCOT WILSON 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	111N00000X	Chiropractor	CH8767	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4605400	OTHER	FL	CIGNA
2	7954734	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851453344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERROD PRESCOT WILSON D.C.

Provider Business Mailing Address
First Line	:	12720 S ORANGE BLOSSOM TRL
Second Line	:	# 20
City	:	ORLANDO
State	:	FL
Zip	:	32837-6225
Country	:	US
Telephone Number	:	407-438-4888
Fax Number	:	407-398-0117

Provider Business Practice Location Address
First Line	:	12720 S ORANGE BLOSSOM TRL
Second Line	:	# 20
City	:	ORLANDO
State	:	FL
Zip	:	32837-6225
Country	:	US
Telephone Number	:	407-438-4888
Fax Number	:	407-398-0117

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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