Provider Demographics
NPI:1720363310
Name:DENSTEDT, SAMANTHA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MARIE
Last Name:DENSTEDT
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 1:4515 ORANGEWOOD LOOP E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1847
Mailing Address - Country:US
Mailing Address - Phone:863-670-5137
Mailing Address - Fax:
Practice Address - Street 1:1820 E COUNTY ROAD 540A
Practice Address - Street 2:WELLNESS
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3737
Practice Address - Country:US
Practice Address - Phone:863-670-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor