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General NPI Number Information
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NPI Number | 1972284990
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Entity Type | Organization
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Legal Business Name | SOVEREIGNTY CHIROPRACTIC INC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 2626 CYPRESS RIDGE BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6315
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Country | US
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Telephone | 813-560-5323
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Fax | 813-863-1911
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Provider Business Mailing Address
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Address Line | 8220 PELICAN REED CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-5158
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Country | US
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Telephone | 919-356-5680
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Fax | 813-863-1911
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. SCOTT COUNCILMAN II
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Credential | DC
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Telephone | 813-560-5323
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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 |
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License Number State |
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