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General NPI Number Information
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NPI Number | 1699604421
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Entity Type | Organization
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Legal Business Name | WILD BLUE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/18/2026
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Last Update Date | 05/18/2026
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Provider Practice Location Address
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Address Line | 16050 S TAMIAMI TRL STE 108
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City | FORT MYERS
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State | FL
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Zip | 33908-4243
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Country | US
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Telephone | 239-270-5873
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Fax |
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Provider Business Mailing Address
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Address Line | 16050 S TAMIAMI TRL STE 108
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City | FORT MYERS
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State | FL
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Zip | 33908-4243
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Country | US
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Telephone | 239-270-5873
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. KRISTIN DEARMOND
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Credential | DC
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Telephone | 239-270-5876
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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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