Provider Demographics
NPI:1902235732
Name:100 PERCENT CHIROPRACTIC TAMPA 1, LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC TAMPA 1, LLC
Other - Org Name:100 PERCENT TAMPA 1, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-510-3986
Mailing Address - Street 1:9906 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1858
Mailing Address - Country:US
Mailing Address - Phone:813-510-3986
Mailing Address - Fax:
Practice Address - Street 1:9906 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1858
Practice Address - Country:US
Practice Address - Phone:813-510-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty