Healthcare Provider Details

I. General information

NPI: 1881668077
Provider Name (Legal Business Name): JEFFERY JOSEPH KROMOLICKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 MITCHELL BLVD
TRINITY FL
34655-4408
US

IV. Provider business mailing address

8915 MITCHELL BLVD
TRINITY FL
34655-4408
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-7557
  • Fax: 727-375-9958
Mailing address:
  • Phone: 727-375-7557
  • Fax: 727-375-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0007844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: