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NPI Code Detail

MEDICARE: TAMPA SPORT & SPINE

MEDICARE: TAMPA SPORT & SPINE
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
1261Q00000XClinic/CenterCH10885FL

General Provider Information

NPI Number : 1275933681
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAMPA SPORT & SPINE
Provider Business Mailing Address
First Line : 170 ACKLINS CIR
Second Line : APARTMENT 308
City : DAYTONA BEACH
State : FL
Zip : 32119-9781
Country : US
Telephone Number : 813-230-3607
Fax Number :
Provider Business Practice Location Address
First Line : 949 BEVILLE RD
Second Line : D5
City : SOUTH DAYTONA
State : FL
Zip : 32119-1705
Country : US
Telephone Number : 813-230-3607
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. TAYLOR JOURDAN LEVICK
Credential : DC
Telephone Number : 813-230-3607
Provider Enumeration Date : 09/04/2014
Last Update Date : 09/04/2014

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Directions to “TAMPA SPORT & SPINE ” Practice Location

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