=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881856318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK SPRINGER DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 01/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2441 US HIGHWAY 98 W SUITE 103
-----------------------------------------------------
City | SANTA ROSA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32459-5385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-622-0062
-----------------------------------------------------
Fax | 850-622-0007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4221 N HIMES AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-874-7217
-----------------------------------------------------
Fax | 813-769-0884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH 9550
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------