Provider Demographics
NPI:1215113261
Name:DORAZIO, DORAN R (DC)
Entity type:Individual
Prefix:
First Name:DORAN
Middle Name:R
Last Name:DORAZIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W WATERS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2758
Mailing Address - Country:US
Mailing Address - Phone:813-935-2099
Mailing Address - Fax:813-935-1388
Practice Address - Street 1:3333 W WATERS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2758
Practice Address - Country:US
Practice Address - Phone:813-935-2099
Practice Address - Fax:813-935-1388
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T95241Medicare UPIN
FL88825Medicare PIN