Provider Demographics
NPI:1073671103
Name:SEABREEZE MEDICAL NETWORK INC
Entity Type:Organization
Organization Name:SEABREEZE MEDICAL NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-887-3661
Mailing Address - Street 1:7918 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4608
Mailing Address - Country:US
Mailing Address - Phone:813-887-3661
Mailing Address - Fax:
Practice Address - Street 1:7918 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4608
Practice Address - Country:US
Practice Address - Phone:813-887-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K8882OtherGROUP
K8882OtherGROUP
70086AMedicare ID - Type Unspecified