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General NPI Number Information
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NPI Number | 1770071011
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Entity Type | Organization
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Legal Business Name | RISE CHIROPRACTIC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 348 MIRACLE STRIP PKWY SW STE 20
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5263
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Country | US
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Telephone | 574-229-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 348 MIRACLE STRIP PKWY SW STE 20
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5263
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Country | US
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Telephone | 574-229-4177
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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. ELIZABETH SNOW
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Credential | DC
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Telephone | 574-229-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH11998
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License Number State | FL
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