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4221 Commons Dr East, Ste B-105, Deston, FL 32541-3483 | |
(850) 650-6789 | |
(850) 650-6790 |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | 4221 Commons Dr East, Deston, Florida |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1275857385 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | CH9683 (Florida) | Primary |
Provider Name | Timothy Douglass |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1306913884 PECOS PAC ID: 3678543824 Enrollment ID: I20111121000900 |
Mailing Address | Practice Location Address |
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4421 Commons Dr E, # B-105, Destin, FL 32541-3484 Ph: (850) 650-6789 | 4221 Commons Dr East, Ste B-105, Deston, FL 32541-3483 Ph: (850) 650-6789 |