Provider Demographics
NPI:1124518774
Name:WEST CHIROPRACTIC & NEUROPATHY CENTER LLC
Entity type:Organization
Organization Name:WEST CHIROPRACTIC & NEUROPATHY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-456-5326
Mailing Address - Street 1:7900 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4108
Mailing Address - Country:US
Mailing Address - Phone:727-577-0004
Mailing Address - Fax:
Practice Address - Street 1:7900 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4108
Practice Address - Country:US
Practice Address - Phone:727-577-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty