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General NPI Number Information
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NPI Number | 1689800799
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Entity Type | Organization
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Legal Business Name | CLYDELL DEWBERRY DC PA
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 9710 STIRLING ROAD SUITE 112
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City | COOPER CITY
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-745-8416
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Fax |
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Provider Business Mailing Address
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Address Line | 9710 STIRLING ROAD SUITE 112
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City | COOPER CITY
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-745-8416
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | CLYDELL LORAN DEWBERRY
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Credential | D.C.
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Telephone | 954-745-8416
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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 | CH9460
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License Number State | FL
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