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General NPI Number Information
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NPI Number | 1790297588
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Entity Type | Organization
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Legal Business Name | HEALING PURPOSE CHIROPRACTIC, PA
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 68 BEAL PARKWAY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5331
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Country | US
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Telephone | 850-362-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 68 BEAL PKWY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5331
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Country | US
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Telephone | 770-309-5600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CARL S JEROME
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Credential | DC
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Telephone | 850-362-6767
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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 | CH11507
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License Number State | FL
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