MEDICARE: DR. ADAM N TICE N.D.

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	175F00000X	Naturopath	099.0074285	VT

General Provider Information

NPI Number	:	1982909974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM N TICE N.D.

Provider Business Mailing Address
First Line	:	105 S RIVERSIDE DR STE 131
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-409-0044
Fax Number	:	321-409-0099

Provider Business Practice Location Address
First Line	:	105 S RIVERSIDE DR STE 131
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-409-0044
Fax Number	:	321-409-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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