Provider Demographics
NPI:1659513042
Name:EPPS, MYLISA L (DC)
Entity Type:Individual
Prefix:
First Name:MYLISA
Middle Name:L
Last Name:EPPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BUCKHORN RUN DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5766
Mailing Address - Country:US
Mailing Address - Phone:813-625-2867
Mailing Address - Fax:
Practice Address - Street 1:701 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3100
Practice Address - Country:US
Practice Address - Phone:813-239-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor