MEDICARE: BOBEN, 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	CH4435	FL
2	171100000X	Acupuncturist	AP2591	FL
3	225700000X	Massage Therapist	MA24586	FL

General Provider Information

NPI Number	:	1871815951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBEN, LLC

Provider Business Mailing Address
First Line	:	3864 SAN JOSE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4613
Country	:	US
Telephone Number	:	904-737-8552
Fax Number	:	904-737-8113

Provider Business Practice Location Address
First Line	:	3864 SAN JOSE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4613
Country	:	US
Telephone Number	:	904-737-8552
Fax Number	:	904-737-8113

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR/BILLER
Name	:	MRS. JENNIFER LEAH RANKIN
Credential	:
Telephone Number	:	904-737-8552

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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Directions to “BOBEN, LLC ” Practice Location

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