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General NPI Number Information
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NPI Number | 1356617955
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Entity Type | Organization
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Legal Business Name | HOLISTIC INSTITUTE OF SO. FL, INC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 2480 SO. CONGRESS AVE SUITE A-2
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-7615
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Country | US
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Telephone | 561-641-7997
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Fax | 561-641-2461
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Provider Business Mailing Address
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Address Line | 2480 SO. CONGRESS AVE. SUITE A-2
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-7615
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Country | US
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Telephone | 561-641-7997
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Fax | 561-641-2461
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Authorized Official
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Title or Position | PRES
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Name | MR. JERRY ALLEN TANKERSLEY
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Credential | D.C.
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Telephone | 561-641-7997
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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 | CH1502
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License Number State | FL
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