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General NPI Number Information
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NPI Number | 1598203283
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Entity Type | Organization
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Legal Business Name | RAYMOND G NIETZOLD DC, PA
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 1745 S HIGHLAND AVE STE 2
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City | CLEARWATER
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State | FL
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Zip | 33756-1852
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Country | US
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Telephone | 727-585-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 S HIGHLAND AVE STE 2
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City | CLEARWATER
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State | FL
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Zip | 33756-1852
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Country | US
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Telephone | 727-585-4488
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND GEORGE NIETZOLD
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Credential | D.C.
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Telephone | 727-585-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | CH0004038
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License Number State | FL
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