Healthcare Provider Details

I. General information

NPI: 1598203283
Provider Name (Legal Business Name): RAYMOND G NIETZOLD DC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 S HIGHLAND AVE STE 2
CLEARWATER FL
33756-1852
US

IV. Provider business mailing address

1745 S HIGHLAND AVE STE 2
CLEARWATER FL
33756-1852
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-4488
  • Fax:
Mailing address:
  • Phone: 727-585-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH0004038
License Number StateFL

VIII. Authorized Official

Name: DR. RAYMOND GEORGE NIETZOLD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 727-585-4488