MEDICARE: DENASAN SPALLA DC

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	15302	FL

General Provider Information

NPI Number	:	1881403749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENASAN SPALLA DC

Provider Business Mailing Address
First Line	:	3423 HAYES BAYOU DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6158
Country	:	US
Telephone Number	:	740-263-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1212
Country	:	US
Telephone Number	:	727-823-4663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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Directions to “ DENASAN SPALLA DC” Practice Location

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