Organization
TMJ TX CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. INA MARIE CHANCEY MS/CCC/SLP (OWNER)
(727) 813-0475
Entity
Organization
Contact information
Practice address
8649 REGENCY PARK BLVD, PORT RICHEY, FL 34668-5742
(727) 813-0475
Mailing address
8649 REGENCY PARK BLVD, PORT RICHEY, FL 34668-5742
(727) 843-4035
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
SA 1638
FL
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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