Healthcare Provider Details

I. General information

NPI: 1164568796
Provider Name (Legal Business Name): CONFORTI'S CROSSROADS CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 HEALTH CARE DR
TRINITY FL
34655-5363
US

IV. Provider business mailing address

1811 HEALTH CARE DR
TRINITY FL
34655-5363
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-9611
  • Fax: 727-376-0752
Mailing address:
  • Phone: 727-376-9611
  • Fax: 727-376-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7068
License Number StateFL

VIII. Authorized Official

Name: DR. TODD BODANZA
Title or Position: DOCTOR
Credential: D.C.
Phone: 727-376-9611