Healthcare Provider Details

I. General information

NPI: 1811009384
Provider Name (Legal Business Name): SCOTT CHRISTIAN ESENBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24426 STATE ROAD 54
LUTZ FL
33559-7303
US

IV. Provider business mailing address

PO BOX 979
LAND O LAKES FL
34639-0979
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-4440
  • Fax:
Mailing address:
  • Phone: 813-948-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: