| NPI | 1417147885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE LAKE Office Manager 813-254-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8921) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2012-05-17 |