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General NPI Number Information
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NPI Number | 1205252343
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Entity Type | Organization
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Legal Business Name | CROSSWINDS PHYSICIAN SERVICES, INC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 1224 66TH ST NORTH
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City | ST PETERSBURG
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State | FL
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Zip | 33710
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Country | US
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Telephone | 727-347-3400
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Fax | 727-347-0502
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Provider Business Mailing Address
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Address Line | 1224 66TH ST NORTH
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City | ST PETERSBURG
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State | FL
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Zip | 33710
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Country | US
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Telephone | 727-347-3400
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Fax | 727-347-0502
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | FRED S FREED
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Credential | DC
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Telephone | 727-347-3400
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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 | CH5113
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License Number State | FL
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