MEDICARE: FLORIDA CHIROPRACTIC HEALTH CENTER

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	CH9040	FL

General Provider Information

NPI Number	:	1982035770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA CHIROPRACTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	1900 BOOTHE CIRCLE
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32822-8232
Country	:	US
Telephone Number	:	407-730-9311
Fax Number	:	407-730-9310

Provider Business Practice Location Address
First Line	:	7806 LAKE UNDERHILL ROAD
Second Line	:	SUITE 104
City	:	ORLANDO
State	:	FL
Zip	:	32822-6751
Country	:	US
Telephone Number	:	407-774-6800
Fax Number	:	407-774-6806

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. EDUARDO TOBENAS
Credential	:	DC
Telephone Number	:	407-774-6800

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/11/2013

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