Healthcare Provider Details

I. General information

NPI: 1245732171
Provider Name (Legal Business Name): NMS PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 OAKFIELD DR
BRANDON FL
33511
US

IV. Provider business mailing address

1450 OAKFIELD DR
BRANDON FL
33511-4853
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-7246
  • Fax: 813-655-7266
Mailing address:
  • Phone: 813-655-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11815
License Number StateFL

VIII. Authorized Official

Name: DR. LESLIE ANN MARTINEZ
Title or Position: OWNER
Credential: DC
Phone: 813-655-7246