MEDICARE: SOCC PL

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	111NR0400X	Rehabilitation Chiropractor	CH6499	FL
2	111N00000X	Chiropractor	CH6499	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	:	1861450652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCC PL

Provider Business Mailing 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	:	407-857-0122

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	:	407-857-0122

Authorized Official
Title or Position	:	CLINIC DIRECTOR CHIROPRACTOR
Name	:	MR. JEFFREY N. SHEBOVSKY
Credential	:	DC
Telephone Number	:	407-857-6166

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/06/2009

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