Organization Name: | DOCKSIDE CHIROPRACTIC LLC |
NPI Number: | 1518347061 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN CHRISTOPHER POULSTON (OWNER) |
Mailing Address: | 1300 Pinetree Dr Ste 7 Indian Harbour Beach |
State: | FL US |
Postal Code: | 329374429 |
Phone Number: | 3217753734 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2015 |
NPI Last Update Date: | 05/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 302R00000X |
License Number: | CH11291 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Managed Care Organizations |
Taxonomy Classification: | Health Maintenance Organization |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |