Healthcare Provider Details

I. General information

NPI: 1235458126
Provider Name (Legal Business Name): JASON PAUL HURLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N TAMPA ST UNIT 2C
TAMPA FL
33602-4815
US

IV. Provider business mailing address

509 N TAMPA ST UNIT 2C
TAMPA FL
33602-4815
US

V. Phone/Fax

Practice location:
  • Phone: 813-393-6578
  • Fax:
Mailing address:
  • Phone: 813-393-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH-9953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: