Provider Demographics
NPI:1215139159
Name:NORTH FLORIDA CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:NORTH FLORIDA CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-362-2022
Mailing Address - Street 1:1441 OHIO AVE N
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4817
Mailing Address - Country:US
Mailing Address - Phone:386-362-2022
Mailing Address - Fax:386-362-2011
Practice Address - Street 1:1441 OHIO AVE N
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4817
Practice Address - Country:US
Practice Address - Phone:386-362-2022
Practice Address - Fax:386-362-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH008550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9587Medicare PIN