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General NPI Number Information
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NPI Number | 1164227856
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Entity Type | Organization
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Legal Business Name | LONGEVITY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 4525 CHINKAPIN DR
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City | SARASOTA
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State | FL
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Zip | 34232-2475
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Country | US
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Telephone | 615-713-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 CHINKAPIN DR
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City | SARASOTA
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State | FL
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Zip | 34232-2475
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Country | US
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Telephone | 615-713-8982
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | GRAYSON FOX
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Credential | D.C.
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Telephone | 615-713-8982
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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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