Provider Demographics
NPI:1235405135
Name:ROYAL PALM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROYAL PALM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-400-4807
Mailing Address - Street 1:1180 PONCE DE LEON BLVD STE 601B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1031
Mailing Address - Country:US
Mailing Address - Phone:727-400-4807
Mailing Address - Fax:727-400-4809
Practice Address - Street 1:1180 PONCE DE LEON BLVD STE 601B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1031
Practice Address - Country:US
Practice Address - Phone:727-400-4807
Practice Address - Fax:727-400-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty