MEDICARE: DR. DAMON J STAFFORD 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	CH8146	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770650574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMON J STAFFORD DC

Provider Business Mailing Address
First Line	:	4025 TAMPA RD STE 1106
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3213
Country	:	US
Telephone Number	:	813-491-4480
Fax Number	:	813-315-7233

Provider Business Practice Location Address
First Line	:	4025 TAMPA RD STE 1106
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3213
Country	:	US
Telephone Number	:	813-491-4480
Fax Number	:	813-315-7233

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/20/2024

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