Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | CH12397 | FL |
NPI | 1982102547 |
---|---|
Provider Name | Carissa Hughes |
First Address | Lithia, FL 33547-4165 |
Second Address | Lithia, FL 33547-4165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 03/10/2019 |