Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA64424 | FL |
NPI | 1063777563 |
---|---|
Provider Name | Jaime Alexander Pacheco |
First Address | Tampa, FL 33634 |
Second Address | Tampa, FL 33615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 10/07/2012 |