Provider Demographics
NPI:1295157527
Name:BOOTH, I. MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:I. MARIE
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:107 BAY BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7428
Mailing Address - Country:US
Mailing Address - Phone:850-932-1778
Mailing Address - Fax:850-934-4770
Practice Address - Street 1:107 BAY BRIDGE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7428
Practice Address - Country:US
Practice Address - Phone:850-932-1778
Practice Address - Fax:850-934-4770
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12263111N00000X
VA0104557129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor