Provider Demographics
NPI:1821320136
Name:SUNCOAST TOTAL HEALTHCARE OF TAMPA, LLC
Entity Type:Organization
Organization Name:SUNCOAST TOTAL HEALTHCARE OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-410-7301
Mailing Address - Street 1:2901 W HILLSBOROUGH AVE # C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6054
Mailing Address - Country:US
Mailing Address - Phone:727-726-1460
Mailing Address - Fax:727-669-7138
Practice Address - Street 1:2901 W HILLSBOROUGH AVE # C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6054
Practice Address - Country:US
Practice Address - Phone:727-726-1460
Practice Address - Fax:727-669-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty