Provider Demographics
NPI:1235871690
Name:ROUNSAVALL, DAVID BLAKE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BLAKE
Last Name:ROUNSAVALL
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 1:981 HIGHWAY 98 E STE 9
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2588
Mailing Address - Country:US
Mailing Address - Phone:850-460-2362
Mailing Address - Fax:850-460-2690
Practice Address - Street 1:221 E 23RD ST STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4557
Practice Address - Country:US
Practice Address - Phone:850-215-1747
Practice Address - Fax:850-215-1748
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor