MEDICARE: DR. GEORGE WILLIAM STOVALL D.C.

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
1	111N00000X	Chiropractor	CH5415	FL

General Provider Information

NPI Number	:	1063475044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE WILLIAM STOVALL D.C.

Provider Business Mailing Address
First Line	:	3950 3RD ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-6123
Country	:	US
Telephone Number	:	727-823-4669
Fax Number	:	727-822-2329

Provider Business Practice Location Address
First Line	:	3950 3RD ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-6123
Country	:	US
Telephone Number	:	727-823-4669
Fax Number	:	727-822-2329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	11/18/2010

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