1598092025 NPI number — DR. RICHARD TANTILLO FAMILY CHIROPRACTIC CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598092025 NPI number — DR. RICHARD TANTILLO FAMILY CHIROPRACTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. RICHARD TANTILLO FAMILY CHIROPRACTIC CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598092025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2919 ALTERNATE 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-784-1222
Provider Business Mailing Address Fax Number:
727-784-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 ALTERNATE 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-784-1222
Provider Business Practice Location Address Fax Number:
727-784-7888
Provider Enumeration Date:
11/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TANTILLO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
727-784-1222

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8026 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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