| Tallie L Cluxton, DC | |
|
215 Forest Park Cir, Panama City, FL 32405-4916 | |
| (850) 215-5657 | |
| (850) 215-5658 |
| Full Name | Tallie L Cluxton |
|---|---|
| Gender | Female |
| Speciality | Chiropractor |
| Location | 215 Forest Park Cir, Panama City, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477660215 | NPI | - | NPPES |
| 73011 | Other | FL | BCBS OF FL PROVIDER # |
| 78727743 | Other | FL | GREENWAVE AETNA PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | CH8571 (Florida) | Primary |
| Provider Name | Green Wave Family Wellness Center |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1568662864 PECOS PAC ID: 8325059207 Enrollment ID: O20060505000867 |
| Mailing Address | Practice Location Address |
|---|---|
| Tallie L Cluxton, DC 215 Forest Park Cir, Panama City, FL 32405-4916 Ph: (850) 215-5657 | Tallie L Cluxton, DC 215 Forest Park Cir, Panama City, FL 32405-4916 Ph: (850) 215-5657 |
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