MEDICARE: CLAYTON WOODS HOPKINS 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	CH4456	FL

General Provider Information

NPI Number	:	1598768236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON WOODS HOPKINS DC

Provider Business Mailing Address
First Line	:	HOPKINS CLINIC FOR PHYSICAL MEDICINE
Second Line	:	6231 66TH STREET NORTH
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781
Country	:	US
Telephone Number	:	727-544-3330
Fax Number	:	727-544-3221

Provider Business Practice Location Address
First Line	:	HOPKINS CLINIC FOR PHYSICAL MEDICINE
Second Line	:	6231 66TH STREET NORTH
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781
Country	:	US
Telephone Number	:	727-544-3330
Fax Number	:	727-544-3221

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

Provider Enumeration Date	:	05/26/2005
Last Update Date	:	07/08/2007

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