MEDICARE: GREGORY L DOKKA DC PA

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	CH7755	FL
2	111N00000X	Chiropractor
3	363L00000X	Nurse Practitioner

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	:	1588915011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY L DOKKA DC PA

Provider Business Mailing Address
First Line	:	51 SOUTH MAIN AVENUE
Second Line	:	SUITE 315
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3934
Country	:	US
Telephone Number	:	727-447-4255
Fax Number	:	727-449-8198

Provider Business Practice Location Address
First Line	:	51 SOUTH MAIN AVENUE
Second Line	:	SUITE 315
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3934
Country	:	US
Telephone Number	:	727-447-4255
Fax Number	:	727-449-8198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY L DOKKA
Credential	:	D.C.
Telephone Number	:	727-447-4255

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	09/04/2022

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