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General NPI Number Information
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NPI Number | 1154515229
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Entity Type | Organization
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Legal Business Name | DESTIN CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 3999 COMMONS DR SUITE C
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City | DESTIN
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State | FL
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Zip | 32541
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Country | US
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Telephone | 850-654-6912
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Fax | 850-654-9459
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Provider Business Mailing Address
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Address Line | 3999 COMMONS DR SUITE C
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City | DESTIN
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State | FL
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Zip | 32541
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Country | US
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Telephone | 850-654-6912
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Fax | 850-654-9459
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. THOMAS E KRACHT
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Credential | DC
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Telephone | 850-654-6912
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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 | CH6571
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License Number State | FL
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