MEDICARE: DR. THERESA PHAM DC

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	14532	FL

General Provider Information

NPI Number	:	1588355119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA PHAM DC

Provider Business Mailing Address
First Line	:	968 16TH ST
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-4515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	968 16TH ST
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-4515
Country	:	US
Telephone Number	:	727-644-6685
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/16/2023

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Directions to “ DR. THERESA PHAM DC” Practice Location

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