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General NPI Number Information
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NPI Number | 1801196258
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Entity Type | Organization
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Legal Business Name | MEDICAL & CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 4602 N NEBRASKA AVE
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City | TAMPA
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State | FL
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Zip | 33603-4014
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Country | US
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Telephone | 813-237-3791
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Fax | 813-237-3792
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Provider Business Mailing Address
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Address Line | 4602 N NEBRASKA AVE
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City | TAMPA
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State | FL
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Zip | 33603-4014
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Country | US
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Telephone | 813-237-3791
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Fax | 813-237-3792
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY L. WILLIAMS
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Credential | D.C.
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Telephone | 813-237-3791
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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 | CH004212
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License Number State | FL
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