MEDICARE: WILD BLUE 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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1699604421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD BLUE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	16050 S TAMIAMI TRL STE 108
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4243
Country	:	US
Telephone Number	:	239-270-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	16050 S TAMIAMI TRL STE 108
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4243
Country	:	US
Telephone Number	:	239-270-5873
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. KRISTIN DEARMOND
Credential	:	DC
Telephone Number	:	239-270-5876

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “WILD BLUE CHIROPRACTIC LLC ” Practice Location

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