MEDICARE: MINA CHIROPRACTIC & REHAB 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	CH3956	FL

General Provider Information

NPI Number	:	1982833901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINA CHIROPRACTIC & REHAB CENTER

Provider Business Mailing Address
First Line	:	1261 N PINE HILLS RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-6228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 N PINE HILLS RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-6228
Country	:	US
Telephone Number	:	407-295-7528
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	CHARLES RICHARD BAME
Credential	:	DC
Telephone Number	:	407-295-7528

Provider Enumeration Date	:	07/12/2009
Last Update Date	:	07/12/2009

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