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NPI Code Detail

MEDICARE: ROYAL PALM CHIROPRACTIC LLC

MEDICARE: ROYAL PALM CHIROPRACTIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH9721FL

General Provider Information

NPI Number : 1235405135
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROYAL PALM CHIROPRACTIC LLC
Provider Business Mailing Address
First Line : 1180 PONCE DE LEON BLVD STE 601B
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-1031
Country : US
Telephone Number : 727-400-4807
Fax Number : 727-400-4809
Provider Business Practice Location Address
First Line : 1180 PONCE DE LEON BLVD STE 601B
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-1031
Country : US
Telephone Number : 727-400-4807
Fax Number : 727-400-4809
Authorized Official
Title or Position : OWNER
Name : DR. THERESA A MARTIN
Credential : DC
Telephone Number : 727-400-4807
Provider Enumeration Date : 03/26/2012
Last Update Date : 03/26/2012

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Directions to “ROYAL PALM CHIROPRACTIC LLC ” Practice Location

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