Provider Demographics
NPI:1578051041
Name:POTIER, PAUL WOODROW III (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WOODROW
Last Name:POTIER
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:POTIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8798 LAKE TIBET CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5481
Mailing Address - Country:US
Mailing Address - Phone:352-552-4889
Mailing Address - Fax:
Practice Address - Street 1:MOBILE SERVICE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836
Practice Address - Country:US
Practice Address - Phone:352-552-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor