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General NPI Number Information
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NPI Number | 1700144235
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Entity Type | Organization
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Legal Business Name | ST. PETE CHIROPRACTIC AND INJURY CENTER LLC
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 2206 4TH STREET NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33704
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Country | US
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Telephone | 727-822-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 TAMPA RD
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City | OLDSMAR
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State | FL
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Zip | 34677
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Country | US
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Telephone | 727-822-6700
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CARL GERARD CONFORTI
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Credential | D.C.
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Telephone | 727-243-4751
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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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