MEDICARE: TARPON SPINE CENTER, INC

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	CH7441	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164447173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARPON SPINE CENTER, INC

Provider Business Mailing Address
First Line	:	1244 S PINELLAS AVE
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3720
Country	:	US
Telephone Number	:	727-937-2086
Fax Number	:	727-939-2554

Provider Business Practice Location Address
First Line	:	1244 S PINELLAS AVE
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3720
Country	:	US
Telephone Number	:	727-937-2086
Fax Number	:	727-939-2554

Authorized Official
Title or Position	:	OWNER
Name	:	MIKE R MARCELL
Credential	:	DC
Telephone Number	:	727-937-2086

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/02/2020

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1244 S PINELLAS AVE
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34689-3720

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1881739126 — SAL L DELELLIS D.P.M P. A.
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1244 S PINELLAS AVE
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34689-3720

Practice Phone: 727-939-3015
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1568699189 — DR. DAN RICHARD RIESLING D.C.
Practice Location Address:

1244 S PINELLAS AVE
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34689-3720

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Practice Location Address:

1264 S PINELLAS AVE
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34689-3720

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1720657737 — MICHAEL QUILES COLON D.C.
Practice Location Address:

1244 S PINELLAS AVE
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34689-3720

Practice Phone: 727-937-2086
Practice Fax: 727-939-2554

Directions to “TARPON SPINE CENTER, INC ” Practice Location

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