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General NPI Number Information
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NPI Number | 1396263331
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Entity Type | Organization
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Legal Business Name | ESSENTIAL CHIROPRACTIC PA
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 6308 TRAIL BLVD
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City | NAPLES
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State | FL
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Zip | 34108-2836
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Country | US
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Telephone | 239-530-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 6308 TRAIL BLVD
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City | NAPLES
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State | FL
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Zip | 34108-2836
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Country | US
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Telephone | 239-300-0885
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MARYELLA K LOMAN
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Credential | DC, AO PROVIDER
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Telephone | 239-300-0885
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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 | CH6159
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License Number State | FL
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