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General NPI Number Information
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NPI Number | 1366733370
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Entity Type | Organization
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Legal Business Name | MULBERRY CHIROPRACTIC
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 8728 SE 165TH MULBERRY LN
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City | THE VILLAGES
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State | FL
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Zip | 32162-5861
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Country | US
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Telephone | 352-259-4810
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Fax | 352-259-4608
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Provider Business Mailing Address
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Address Line | 8728 SE 165TH MULBERRY LN
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City | THE VILLAGES
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State | FL
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Zip | 32162-5861
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Country | US
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Telephone | 352-259-4810
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Fax | 352-259-4608
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SCOTT STEVEN THOMAS
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Credential | DC
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Telephone | 352-259-4810
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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 | CH10074
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License Number State | FL
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