| NPI | 1316010143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE WAYNE BLAKE Billing Manager 813-818-7499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH7630) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2013-01-24 |