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General NPI Number Information
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NPI Number | 1073568572
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Entity Type | Organization
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Legal Business Name | CHIROMED CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 205 WEST BUSH BLVD
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City | TAMPA
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State | FL
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Zip | 33612
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Country | US
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Telephone | 800-679-7246
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Fax | 912-355-1848
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Provider Business Mailing Address
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Address Line | PO BOX 15639
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City | SAVANNAH
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State | GA
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Zip | 31416-2339
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Country | US
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Telephone | 912-354-5500
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Fax | 912-355-1848
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KEN J. MANGELSDORF
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Credential |
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Telephone | 912-354-5500
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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 |
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License Number State |
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