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General NPI Number Information
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NPI Number | 1336625532
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Entity Type | Organization
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Legal Business Name | BEACHTOWN CHIROPRACTIC CO., LLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 15600 PANAMA CITY BEACH PKWY UNIT 700
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-5430
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Country | US
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Telephone | 334-790-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 323 AIRPORT RD STE C
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City | AUBURN
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State | AL
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Zip | 36830-5701
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Country | US
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Telephone | 334-212-0101
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JEFFREY TYLER GREGORY
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Credential | DC
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Telephone | 334-790-0484
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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 | CH12515
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License Number State | FL
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