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General NPI Number Information
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NPI Number | 1811390016
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Entity Type | Organization
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Legal Business Name | OLDSMAR CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 3906 TAMPA RD SUITE A
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City | OLDSMAR
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State | FL
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Zip | 34677-3100
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Country | US
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Telephone | 813-855-5986
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Fax | 813-855-6378
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Provider Business Mailing Address
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Address Line | 3906 TAMPA RD SUITE A
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City | OLDSMAR
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State | FL
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Zip | 34677-3100
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Country | US
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Telephone | 813-855-5986
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Fax | 813-855-6378
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT FORREST GOLDEN
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Credential | D.C.
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Telephone | 813-855-5986
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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 | CH4140
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License Number State | FL
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