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General NPI Number Information
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NPI Number | 1861798761
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Entity Type | Individual
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Provider Name | MARTINA THEODORA CASTRO D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 350D RACETRACK RD NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1699
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Country | US
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Telephone | 850-837-2933
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 COSTA VERDE CT
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City | NAVARRE
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State | FL
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Zip | 32566-2188
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Country | US
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Telephone | 573-268-0872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH10226
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License Number State | FL
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