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General NPI Number Information
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NPI Number | 1003294497
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Entity Type | Organization
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Legal Business Name | DR. MARY NELLE J. DOTSON,, LLC
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 625 COMMERCE DR STE 102
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City | LAKELAND
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State | FL
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Zip | 33813-2733
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Country | US
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Telephone | 863-660-0038
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Fax |
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Provider Business Mailing Address
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Address Line | 625 COMMERCE DR STE 102
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City | LAKELAND
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State | FL
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Zip | 33813-2733
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Country | US
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Telephone | 863-660-0038
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARY NELLE JAMES DOTSON
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Credential | D.C.
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Telephone | 863-660-0038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10145
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License Number State | FL
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