| |
1400 East Moody Blvd, Bunnell, FL 32110-5916 | |
(386) 313-2599 | |
(386) 313-2577 |
Full Name | |
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Type | Facility |
Speciality | Pain Medicine - Interventional Pain Medicine |
Location | 1400 East Moody Blvd, Bunnell, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1639445596 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | CH9168 (* (Not Available)) | Secondary |
208VP0014X | Pain Medicine - Interventional Pain Medicine | OS10016 (Florida) | Primary |
Mailing Address | Practice Location Address |
---|---|
1400 E Moody Blvd, Bunnell, FL 32110-5916 Ph: (386) 313-2599 | 1400 East Moody Blvd, Bunnell, FL 32110-5916 Ph: (386) 313-2599 |