MEDICARE: DR GOMEZ CHIROPRACTIC, 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	:	1871242347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR GOMEZ CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	13911 N DALE MABRY HWY STE 107
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2414
Country	:	US
Telephone Number	:	727-916-0407
Fax Number	:	813-242-3412

Provider Business Practice Location Address
First Line	:	13911 N DALE MABRY HWY STE 107
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2414
Country	:	US
Telephone Number	:	727-916-0407
Fax Number	:	813-242-3412

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	DR. VICTOR HUGO GOMEZ
Credential	:	DC
Telephone Number	:	727-916-0407

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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