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General NPI Number Information
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NPI Number | 1477963064
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Entity Type | Organization
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Legal Business Name | TAMPA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 3315 W BEARSS AVE
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City | TAMPA
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State | FL
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Zip | 33618-2100
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Country | US
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Telephone | 813-416-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 W BEARSS AVE
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City | TAMPA
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State | FL
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Zip | 33618-2100
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Country | US
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Telephone |
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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. BRENT COONS
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Credential | D.C
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Telephone | 813-416-3555
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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 | CH 11183
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License Number State | FL
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