Provider Demographics
NPI:1972284990
Name:SOVEREIGNTY CHIROPRACTIC INC
Entity type:Organization
Organization Name:SOVEREIGNTY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNCILMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:813-560-5323
Mailing Address - Street 1:8220 PELICAN REED CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5158
Mailing Address - Country:US
Mailing Address - Phone:919-356-5680
Mailing Address - Fax:813-863-1911
Practice Address - Street 1:2626 CYPRESS RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6315
Practice Address - Country:US
Practice Address - Phone:813-560-5323
Practice Address - Fax:813-863-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty