Provider Demographics
NPI:1164684452
Name:CONTRERAS, DAVID G (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2911
Mailing Address - Country:US
Mailing Address - Phone:850-226-6303
Mailing Address - Fax:
Practice Address - Street 1:151 MARY ESTHER BLVD STE 408
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1975
Practice Address - Country:US
Practice Address - Phone:850-226-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor