MEDICARE: DIGITAL MOTION X-RAY OF FLORIDA, 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	111NR0200X	Radiology Chiropractor	CH8235	FL

General Provider Information

NPI Number	:	1881996759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITAL MOTION X-RAY OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 17809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7809
Country	:	US
Telephone Number	:	904-723-5665
Fax Number	:	904-338-0951

Provider Business Practice Location Address
First Line	:	4617 BRENTWOOD AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-6168
Country	:	US
Telephone Number	:	904-350-5544
Fax Number	:	904-350-9944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROYCE MCGOWAN
Credential	:	DC
Telephone Number	:	904-350-5544

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	04/11/2011

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