Organization
DOCKSIDE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN CHRISTOPHER POULSTON DC (OWNER)
(678) 523-8533
Entity
Organization
Contact information
Practice address
1300 PINETREE DR STE 7, INDIAN HARBOUR BEACH, FL 32937-4429
(321) 775-3734
Mailing address
1300 PINETREE DR STE 7, INDIAN HARBOUR BEACH, FL 32937-4429
(321) 775-3734
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
CH11291
FL
Other
Enumeration date
05/30/2015
Last updated
05/30/2015
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