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General NPI Number Information
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NPI Number | 1972812865
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Entity Type | Organization
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Legal Business Name | KENNETH W TRUSSELL DC PA
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 113 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-685-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 113 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-685-4222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KENNETH W TRUSSELL
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Credential | DC
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Telephone | 813-685-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 6246
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License Number State | FL
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