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General NPI Number Information
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NPI Number | 1174068019
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Entity Type | Organization
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Legal Business Name | DESTIN CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 4467 COMMONS DR W STE B
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City | DESTIN
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State | FL
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Zip | 32541-8455
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Country | US
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Telephone | 850-460-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 4467 COMMONS DR W STE B
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City | DESTIN
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State | FL
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Zip | 32541-8455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KATHRYN CLOWER
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Credential | D.C.
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Telephone | 850-460-2333
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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 | CH11791
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH11790
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License Number State | FL
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