MEDICARE: DR. BROOKE IWANSKI DC 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	CH10604	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992219141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. BROOKE IWANSKI DC LLC

Provider Business Mailing Address
First Line	:	1791 BOY SCOUT DR STE 6
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2137
Country	:	US
Telephone Number	:	239-332-2555
Fax Number	:	239-332-2556

Provider Business Practice Location Address
First Line	:	1791 BOY SCOUT DR STE 6
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2137
Country	:	US
Telephone Number	:	239-332-2555
Fax Number	:	239-332-2556

Authorized Official
Title or Position	:	OWNER
Name	:	BROOKE IWANSKI
Credential	:	DC
Telephone Number	:	407-791-4172

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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