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NPI Code Detail

MEDICARE: TROUBLE CREEK CHIROPRACTIC

MEDICARE: TROUBLE CREEK CHIROPRACTIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH9214FL

General Provider Information

NPI Number : 1023552395
Entity Type Code : Organization
Provider Name (Legal Business Name) : TROUBLE CREEK CHIROPRACTIC
Provider Business Mailing Address
First Line : 4515 MADISON ST
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34652-4755
Country : US
Telephone Number : 727-807-5258
Fax Number : 727-807-7644
Provider Business Practice Location Address
First Line : 4515 MADISON ST
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34652-4755
Country : US
Telephone Number : 727-807-5258
Fax Number : 727-807-7644
Authorized Official
Title or Position : OWNER
Name : DR. RONALD FRED STACEY II
Credential : D.C.
Telephone Number : 727-807-5258
Provider Enumeration Date : 12/06/2016
Last Update Date : 12/06/2016

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Directions to “TROUBLE CREEK CHIROPRACTIC ” Practice Location

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