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General NPI Number Information
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NPI Number | 1235405135
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Entity Type | Organization
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Legal Business Name | ROYAL PALM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1180 PONCE DE LEON BLVD STE 601B
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City | CLEARWATER
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State | FL
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Zip | 33756-1031
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Country | US
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Telephone | 727-400-4807
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Fax | 727-400-4809
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Provider Business Mailing Address
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Address Line | 1180 PONCE DE LEON BLVD STE 601B
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City | CLEARWATER
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State | FL
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Zip | 33756-1031
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Country | US
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Telephone | 727-400-4807
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Fax | 727-400-4809
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESA A MARTIN
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Credential | DC
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Telephone | 727-400-4807
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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 | CH9721
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License Number State | FL
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