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General NPI Number Information
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NPI Number | 1568199859
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Entity Type | Organization
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Legal Business Name | KEY CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 6350 GULF OF MEXICO DR STE 103B
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City | LONGBOAT KEY
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State | FL
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Zip | 34228-1501
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Country | US
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Telephone | 941-899-5937
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Fax | 941-383-7742
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Provider Business Mailing Address
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Address Line | PO BOX 8725
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City | LONGBOAT KEY
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State | FL
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Zip | 34228-8725
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Country | US
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Telephone | 941-899-5937
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Fax | 941-383-7742
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER WILLIAMS BIRCH
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Credential | DC
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Telephone | 941-899-5937
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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 |
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License Number State |
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