Healthcare Provider Details

I. General information

NPI: 1114103421
Provider Name (Legal Business Name): CREIGHTON CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 CREIGHTON RD
PENSACOLA FL
32504-7218
US

IV. Provider business mailing address

2110 CREIGHTON RD
PENSACOLA FL
32504-7218
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-8080
  • Fax: 850-473-8816
Mailing address:
  • Phone: 850-473-8080
  • Fax: 850-473-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA R SANGILLO
Title or Position: CHIROPRACTIC PYHSICIAN
Credential: D.O.
Phone: 850-473-8080