| NPI | 1235587676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M MADDOX Owner 813-933-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-05-26 |