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NPI Code Detail

MEDICARE: OLD TARPON CHIROPRACTIC PA

MEDICARE: OLD TARPON CHIROPRACTIC 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
1111N00000XChiropractorCH1469FL

General Provider Information

NPI Number : 1972812642
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLD TARPON CHIROPRACTIC PA
Provider Business Mailing Address
First Line : 4630 DARLINGTON RD
Second Line :
City : HOLIDAY
State : FL
Zip : 34690-3906
Country : US
Telephone Number : 727-942-1618
Fax Number :
Provider Business Practice Location Address
First Line : 4630 DARLINGTON RD
Second Line :
City : HOLIDAY
State : FL
Zip : 34690-3906
Country : US
Telephone Number : 727-942-1618
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ALTON J GUSTAFSON
Credential : D C
Telephone Number : 727-942-1618
Provider Enumeration Date : 09/29/2010
Last Update Date : 09/29/2010

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Directions to “OLD TARPON CHIROPRACTIC PA ” Practice Location

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