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General NPI Number Information
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NPI Number | 1407154875
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Entity Type | Organization
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Legal Business Name | CITRUS REGIONAL CLINIC OF CHIROPRACTIC, PA
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 108 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4819
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Country | US
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Telephone | 352-344-1300
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Fax | 352-341-4500
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Provider Business Mailing Address
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Address Line | 108 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4819
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Country | US
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Telephone | 352-344-1300
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Fax | 352-341-4500
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY A FOWLER
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Credential | D.C.
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Telephone | 352-344-1300
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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 | CH8687
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License Number State | FL
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