Paul Bacon, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH11462 Issued in FL

Practice address

13023 Summerfield Square Dr
Riverview, FL 33578-7402

Phone

(813) 677-9500

Fax

(813) 677-9511

NPI assigned

Mar 9, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kotila Spine & Joint Center of Brandon LLC

  • Interventional Pain Medicine Physician
  • Brandon, FL
  • NPI 1427448406
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609269125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 MARSEILLE CT",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335967248",
            "telephone_number": "813-951-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13023 SUMMERFIELD SQUARE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335787402",
            "telephone_number": "813-677-9500",
            "fax_number": "813-677-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moriam O Ayo Amu, M.D.
• Samih Aysheh, PHARM D.
• Nomen Azeem, MD
• Maria O Babatunde
• Sharon R Baby, PHARMD
• Laura Poliquin Badertscher, CCC/SLP
• Sherif Badra, MD PHD
• Yuslenis Baez Feria
• Jihane Bahbaz
• Tatyanna Bailey

• Chiropractor in Riverview, FL
• Providers in Riverview, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.