Provider Demographics
NPI:1437544491
Name:DRAGOO, THEODORE GARRETT (DC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:GARRETT
Last Name:DRAGOO
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 1:3432 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6301
Mailing Address - Country:US
Mailing Address - Phone:813-603-4466
Mailing Address - Fax:
Practice Address - Street 1:3432 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6301
Practice Address - Country:US
Practice Address - Phone:813-603-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor