Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 2398 | SOUTH CAROLINA | No |
| 2 | 111NI0013X | Chiropractor | Independent Medical Examiner | CH7882 | FLORIDA | No |
| 3 | 111N00000X | Chiropractor | | 6191 | GEORGIA | No |
| 4 | 111N00000X | Chiropractor | | CH7882 | FLORIDA | Yes |
| 5 | 111NX0100X | Chiropractor | Occupational Health | CH7882 | FLORIDA | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | CH7882 | OTHER | FLORIDA | STATE LICENSE NUMBER |
| 2 | 2800039-00 | MEDICAID | FLORIDA | |
| 3 | 350050297 | OTHER | FLORIDA | RAILROAD MEDICARE |
| 4 | 4573235 | OTHER | FLORIDA | GHI PROVIDER NUMBER |
| 5 | 1455405 | OTHER | FLORIDA | CIGNA PROVIDER NUMBER |
| 6 | 53988 | OTHER | FLORIDA | ASHLINK PIN |
| 7 | 55996 | OTHER | FLORIDA | BLUE CROSS NUMBER |
| 8 | 945833 | OTHER | FLORIDA | PPNI PROVIDER NUMBER |
| 9 | K1903 | OTHER | FLORIDA | MEDICARE GROUP NUMBER |
| 10 | P10000175970 | OTHER | FLORIDA | SUNSHINE STATE |
| 11 | 10728811 | OTHER | | CAQH NUMBER |
| 12 | 332352 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 13 | 544703 | OTHER | | WELLCARE/STAYWELL MEDICARE & MEDICAID |
