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General NPI Number Information
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NPI Number | 1982997896
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Entity Type | Organization
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Legal Business Name | HEART OF FLORIDA CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 350 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5602
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Country | US
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Telephone | 863-422-4575
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Fax | 863-422-4573
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Provider Business Mailing Address
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Address Line | 350 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5602
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Country | US
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Telephone | 863-422-4575
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Fax | 863-422-4573
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS CARL GAGNON JR.
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Credential | D.C.
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Telephone | 863-422-4575
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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 | CH10138
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License Number State | FL
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