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General NPI Number Information
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NPI Number | 1245426733
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Entity Type | Organization
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Legal Business Name | CORRECTIVE CARE CHIROPRACTIC LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 4517 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-1295
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Country | US
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Telephone | 941-752-6002
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Fax | 941-752-6008
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Provider Business Mailing Address
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Address Line | 4517 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-1295
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Country | US
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Telephone | 941-752-6002
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Fax | 941-752-6008
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY JAY
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Credential | D.C.
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Telephone | 941-752-6002
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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 | CH8600
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License Number State | FL
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