MEDICARE: ORLANDO CHIROPRACTIC AND PHYSICAL REHAB, 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	CH 10690	FL

General Provider Information

NPI Number	:	1891058806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO CHIROPRACTIC AND PHYSICAL REHAB, LLC

Provider Business Mailing Address
First Line	:	1018 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-4710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-4710
Country	:	US
Telephone Number	:	704-855-6160
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JASON BRENT FARMER
Credential	:	D.C.
Telephone Number	:	803-741-4234

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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