Healthcare Provider Details

I. General information

NPI: 1881715977
Provider Name (Legal Business Name): WHITE SANDS CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BEAL PKWY SW
FORT WALTON BEACH FL
32548-5388
US

IV. Provider business mailing address

24 BEAL PKWY SW
FORT WALTON BEACH FL
32548-5388
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6728
  • Fax: 850-226-6729
Mailing address:
  • Phone: 850-226-6728
  • Fax: 850-226-6729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIK RYAN PERSIANI
Title or Position: OWNER
Credential: D.C.
Phone: 850-226-6728