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General NPI Number Information
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NPI Number | 1720363310
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Entity Type | Individual
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Provider Name | SAMANTHA MARIE DENSTEDT DC
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Gender | Female
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Dates
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Enumeration Date | 10/15/2011
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 1820 E COUNTY ROAD 540A WELLNESS
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City | LAKELAND
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State | FL
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Zip | 33813-3737
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Country | US
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Telephone | 863-670-5137
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 ORANGEWOOD LOOP E
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City | LAKELAND
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State | FL
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Zip | 33813-1847
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Country | US
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Telephone | 863-670-5137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH10414
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License Number State | FL
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