Provider Demographics
NPI:1326787268
Name:PRODIGY HEALTH LLC
Entity Type:Organization
Organization Name:PRODIGY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-492-0370
Mailing Address - Street 1:410 S WARE BLVD STE 815
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4456
Mailing Address - Country:US
Mailing Address - Phone:813-492-0370
Mailing Address - Fax:813-374-4546
Practice Address - Street 1:410 S WARE BLVD STE 815
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4456
Practice Address - Country:US
Practice Address - Phone:813-492-0370
Practice Address - Fax:813-374-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty