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General NPI Number Information
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NPI Number | 1831591262
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Entity Type | Organization
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Legal Business Name | FORT MYERS CHIROPRACTIC STUDIO LLC
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 12655 NEW BRITTANY BLVD # 13W
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City | FORT MYERS
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State | FL
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Zip | 33907-3631
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Country | US
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Telephone | 239-243-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 8971 DANIELS CENTER DR UNIT 304
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City | FORT MYERS
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State | FL
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Zip | 33912-0310
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Country | US
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Telephone | 239-243-8735
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE L HOCH
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Credential | D.C.
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Telephone | 239-243-8735
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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 | CH11279
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License Number State | FL
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