Healthcare Provider Details

I. General information

NPI: 1346512837
Provider Name (Legal Business Name): DYNAMIC TOTAL HEALTH, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 E LAKE RD SUITE 412
PALM HARBOR FL
34685-2407
US

IV. Provider business mailing address

29901 US HIGHWAY 19 N
CLEARWATER FL
33761-1041
US

V. Phone/Fax

Practice location:
  • Phone: 727-286-6203
  • Fax: 727-286-6204
Mailing address:
  • Phone: 727-286-6203
  • Fax: 727-286-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10333
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5939
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME36242
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME79221
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9266947
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3356552
License Number StateFL

VIII. Authorized Official

Name: ERIC EDGERTON
Title or Position: OWNER
Credential: D.C.
Phone: 727-286-6203