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General NPI Number Information
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NPI Number | 1437409885
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Entity Type | Organization
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Legal Business Name | FORT WALTON BEACH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 315 RACETRACK RD NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2548
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Country | US
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Telephone | 850-200-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 315 RACETRACK RD NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2548
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Country | US
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Telephone | 850-200-4911
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SCOTT SMITH
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Credential | D.C.
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Telephone | 850-200-4911
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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 | CH8625
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License Number State | FL
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