Provider Demographics
NPI:1124267059
Name:TRUEHEART CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:TRUEHEART CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TRUEHEART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-293-8686
Mailing Address - Street 1:589 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4215
Mailing Address - Country:US
Mailing Address - Phone:863-293-8686
Mailing Address - Fax:863-299-1764
Practice Address - Street 1:589 AVENUE K SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4215
Practice Address - Country:US
Practice Address - Phone:863-293-8686
Practice Address - Fax:863-299-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2211YMedicare PIN
FLBX436AMedicare PIN
FLU99795Medicare UPIN