MEDICARE: KILTED CHIRO LLC

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

General Provider Information

NPI Number	:	1366033375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KILTED CHIRO LLC

Provider Business Mailing Address
First Line	:	6718 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5659
Country	:	US
Telephone Number	:	813-787-6764
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5659
Country	:	US
Telephone Number	:	813-787-6764
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ADAM STOUT
Credential	:	DC
Telephone Number	:	813-787-6764

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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Directions to “KILTED CHIRO LLC ” Practice Location

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