Provider Demographics
NPI:1346512837
Name:DYNAMIC TOTAL HEALTH, L.L.C
Entity Type:Organization
Organization Name:DYNAMIC TOTAL HEALTH, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-286-6203
Mailing Address - Street 1:29901 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1041
Mailing Address - Country:US
Mailing Address - Phone:727-286-6203
Mailing Address - Fax:727-286-6204
Practice Address - Street 1:3444 E LAKE RD
Practice Address - Street 2:SUITE 412
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2407
Practice Address - Country:US
Practice Address - Phone:727-286-6203
Practice Address - Fax:727-286-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10333111N00000X
FL111N00000X
FLOS5939207Q00000X
FLME36242207Q00000X
FLME79221207Q00000X
FLARNP9266947363L00000X
FLARNP3356552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL220HDOtherBCBS