=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922325489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULFVIEW CHIROPRACTIC & WELLNESS CLINIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2010
-----------------------------------------------------
Last Update Date | 04/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8323 US HIGHWAY 19
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-847-4611
-----------------------------------------------------
Fax | 727-842-3524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8323 US HIGHWAY 19
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-847-4611
-----------------------------------------------------
Fax | 727-842-3524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHARLES FRANKLIN HALLEY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 727-847-4611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH3875
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------