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General NPI Number Information
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NPI Number | 1114376282
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Entity Type | Organization
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Legal Business Name | SUNRISE BODY REVIVAL CHIROPRACTIC AND MASSSAGE
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 3117 W COLUMBUS DR SUITE 206
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City | TAMPA
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State | FL
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Zip | 33607-1866
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Country | US
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Telephone | 813-857-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 W COLUMBUS DR SUITE 206
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City | TAMPA
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State | FL
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Zip | 33607-1866
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Country | US
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Telephone | 813-857-6171
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Fax |
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Authorized Official
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Title or Position | OWWNER
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Name | DR. TRAVIS FRANCE
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Credential | DC
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Telephone | 813-857-6171
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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 | CH11315
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License Number State | FL
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