MEDICARE: DR. SEAN L. PRICE, PA

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89671Z	OTHER	FL	MEDICARE ID TYPE UNSPECIF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	89671	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1871773820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SEAN L. PRICE, PA

Provider Business Mailing Address
First Line	:	745C BEAL PKWY NW
Second Line	:	SUITE 2
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3093
Country	:	US
Telephone Number	:	850-862-2224
Fax Number	:	850-862-2204

Provider Business Practice Location Address
First Line	:	745C BEAL PKWY NW
Second Line	:	SUITE 2
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3093
Country	:	US
Telephone Number	:	850-862-2224
Fax Number	:	850-862-2204

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. SEAN LEE PRICE
Credential	:	DC
Telephone Number	:	850-862-2224

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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Directions to “DR. SEAN L. PRICE, PA ” Practice Location

Language	Start Address	Practice Location

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