| NPI | 1568970903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDIA J POULIN Credentialing Specialist 727-820-1040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2018-01-19 |