MEDICARE: SOVEREIGNTY CHIROPRACTIC INC

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	:	1972284990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOVEREIGNTY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	8220 PELICAN REED CIR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33545-5158
Country	:	US
Telephone Number	:	919-356-5680
Fax Number	:	813-863-1911

Provider Business Practice Location Address
First Line	:	2626 CYPRESS RIDGE BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6315
Country	:	US
Telephone Number	:	813-560-5323
Fax Number	:	813-863-1911

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. SCOTT COUNCILMAN II
Credential	:	DC
Telephone Number	:	813-560-5323

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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