MEDICARE: DAVID BLAKE ROUNSAVALL D.C.

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
1	111N00000X	Chiropractor	CH14009	FL

General Provider Information

NPI Number	:	1235871690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BLAKE ROUNSAVALL D.C.

Provider Business Mailing Address
First Line	:	981 HIGHWAY 98 E STE 9
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2588
Country	:	US
Telephone Number	:	850-460-2362
Fax Number	:	850-460-2690

Provider Business Practice Location Address
First Line	:	221 E 23RD ST STE A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4557
Country	:	US
Telephone Number	:	850-215-1747
Fax Number	:	850-215-1748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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