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General NPI Number Information
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NPI Number | 1609144260
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Entity Type | Organization
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Legal Business Name | NORTHDALE'S FAMILY CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 14855 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33618-2027
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Country | US
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Telephone | 813-960-8447
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Fax | 813-960-8416
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Provider Business Mailing Address
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Address Line | 14855 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33618-2027
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Country | US
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Telephone | 813-960-8447
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Fax | 813-960-8416
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BRUCE DONALD HORCHAK
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Credential | D.C.
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Telephone | 813-960-8447
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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 | CH0006486
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License Number State | FL
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