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General NPI Number Information
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NPI Number | 1235662636
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Entity Type | Organization
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Legal Business Name | TKD HEALTHCARE SERVICES
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 556 E SR 44
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City | WILDWOOD
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State | FL
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Zip | 34785-9474
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Country | US
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Telephone | 352-643-1034
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Fax |
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Provider Business Mailing Address
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Address Line | 4470 VERMILLION SKY DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7375
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Country | US
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Telephone | 727-457-6627
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BETHANY JUNE DIXON
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Credential | DC RD LDN
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Telephone | 352-643-1034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | CH11281
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License Number State | FL
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