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General NPI Number Information
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NPI Number | 1275857385
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Entity Type | Organization
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Legal Business Name | TIMOTHY DOUGLASS DC PA
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 4221 COMMONS DR EAST STE B-105
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City | DESTON
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State | FL
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Zip | 32541-3483
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Country | US
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Telephone | 850-650-6789
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Fax | 850-650-6790
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Provider Business Mailing Address
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Address Line | 4421 COMMONS DR E # B-105
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City | DESTIN
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State | FL
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Zip | 32541-3484
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Country | US
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Telephone | 850-650-6789
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Fax | 850-650-6790
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY D DOUGLASS
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Credential | D.C.
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Telephone | 850-650-6789
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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 | CH9683
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License Number State | FL
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