Healthcare Provider Details

I. General information

NPI: 1538491881
Provider Name (Legal Business Name): COMFORT CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 RON BEATTY BLVD STE B-1
MICCO FL
32976-7471
US

IV. Provider business mailing address

7294 TOPAZ DR
GRANT FL
32949-8323
US

V. Phone/Fax

Practice location:
  • Phone: 305-783-8333
  • Fax:
Mailing address:
  • Phone: 305-783-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA JEAN POTTHOFF
Title or Position: PRESIDENT
Credential: D.C.
Phone: 305-783-8333