Basic Information
| Provider Information | |||||||||
| NPI: | 1609269125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2307 MARSEILLE CT | ||||||||
| Address2: | |||||||||
| City: | VALRICO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335967248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139512447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13023 SUMMERFIELD SQUARE DR | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335787402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136779500 | ||||||||
| FaxNumber: | 8136779511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH11462 | FL | Y | Chiropractic Providers | Chiropractor |
No ID Information.