Provider Demographics
NPI:1154515229
Name:DESTIN CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DESTIN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-654-6912
Mailing Address - Street 1:3999 COMMONS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541
Mailing Address - Country:US
Mailing Address - Phone:850-654-6912
Mailing Address - Fax:850-654-9459
Practice Address - Street 1:3999 COMMONS DR
Practice Address - Street 2:SUITE C
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-654-6912
Practice Address - Fax:850-654-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22847OtherPROVIDER
FLU23023Medicare UPIN