Healthcare Provider Details

I. General information

NPI: 1669998407
Provider Name (Legal Business Name): MATTHEW CAULFIELD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 1ST AVE N
ST PETERSBURG FL
33713-8407
US

IV. Provider business mailing address

3600 1ST AVE N
ST PETERSBURG FL
33713-8407
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-4522
  • Fax: 727-327-8069
Mailing address:
  • Phone: 727-327-4522
  • Fax: 727-327-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: