Healthcare Provider Details

I. General information

NPI: 1164835401
Provider Name (Legal Business Name): TAMPA BAY MUA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 N. ARMENIA AVE
TAMPA FL
33607
US

IV. Provider business mailing address

PO BOX 151556
TAMPA FL
33684-1556
US

V. Phone/Fax

Practice location:
  • Phone: 813-933-5259
  • Fax: 813-935-3698
Mailing address:
  • Phone: 813-933-5259
  • Fax: 813-935-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. MATTHEW U BRECHER
Title or Position: OWNER
Credential: D.C.
Phone: 813-933-5259