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General NPI Number Information
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NPI Number | 1477826840
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Entity Type | Organization
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Legal Business Name | 1SPINE CHIROPRACTIC AND REHABILITATION OLDSMAR
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 3687 TAMPA RD SUITE 202
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City | OLDSMAR
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State | FL
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Zip | 34677-6307
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Country | US
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Telephone | 813-220-0680
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Fax |
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Provider Business Mailing Address
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Address Line | 3687 TAMPA RD SUITE 202
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City | OLDSMAR
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State | FL
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Zip | 34677-6307
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Country | US
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Telephone | 813-220-0680
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. NOAH RICHARD DANIEL
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Credential | DC
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Telephone | 813-220-0680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CH8383
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License Number State | FL
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