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General NPI Number Information
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NPI Number | 1700180916
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Entity Type | Organization
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Legal Business Name | OCEAN CHIROPRACTIC & LASER CENTER, LLC
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 4707 W GANDY BLVD STE 4
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City | TAMPA
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State | FL
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Zip | 33611-3310
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Country | US
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Telephone | 813-374-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 S DALE MABRY HWY UNIT A
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City | TAMPA
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State | FL
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Zip | 33629-8656
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Country | US
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Telephone | 813-374-0116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN WILLIAM WARREN
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Credential | D.C.
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Telephone | 813-374-0116
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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 | CH9734
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License Number State | FL
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