Provider Demographics
NPI:1154767135
Name:CLEARWATER MEDICAL AND CONSULTING LLC
Entity type:Organization
Organization Name:CLEARWATER MEDICAL AND CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CLEARWATER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-335-9669
Mailing Address - Street 1:PO BOX 272849
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2849
Mailing Address - Country:US
Mailing Address - Phone:813-335-9669
Mailing Address - Fax:813-793-4690
Practice Address - Street 1:6166 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6835
Practice Address - Country:US
Practice Address - Phone:727-495-7246
Practice Address - Fax:727-495-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty