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General NPI Number Information
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NPI Number | 1124307921
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Entity Type | Organization
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Legal Business Name | TAMPA BAY WELLNESS ALLIANCE LLC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 9375 US HIGHWAY 19 N SUITE A
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City | PINELLAS PARK
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State | FL
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Zip | 33782-5419
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Country | US
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Telephone | 727-323-4507
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Fax | 727-323-1697
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Provider Business Mailing Address
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Address Line | 9375 US HIGHWAY 19 N SUITE A
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City | PINELLAS PARK
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State | FL
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Zip | 33782-5419
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Country | US
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Telephone | 727-323-4507
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Fax | 727-323-1697
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ADRIENNE HALL
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Credential | DC
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Telephone | 727-323-4507
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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 | CH5547
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License Number State | FL
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