Healthcare Provider Details

I. General information

NPI: 1982988465
Provider Name (Legal Business Name): EAST-WEST CHIROPRACTIC & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 78TH AVE N SUITE 13
PINELLAS PARK FL
33781-2400
US

IV. Provider business mailing address

5030 78TH AVE N SUITE 13
PINELLAS PARK FL
33781-2400
US

V. Phone/Fax

Practice location:
  • Phone: 727-576-6042
  • Fax: 727-576-6582
Mailing address:
  • Phone: 727-576-6042
  • Fax: 727-576-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9063
License Number StateFL

VIII. Authorized Official

Name: DR. MAYUR M RESHAMWALA
Title or Position: PHYSCIAN/OWNER
Credential: D.C.
Phone: 727-576-6042