Provider Demographics
NPI:1215241344
Name:RACINE CHIROPRACTIC CENTER, PA
Entity type:Organization
Organization Name:RACINE CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:RACINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-677-8881
Mailing Address - Street 1:6916 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7003
Mailing Address - Country:US
Mailing Address - Phone:407-677-8881
Mailing Address - Fax:407-677-0705
Practice Address - Street 1:6916 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7003
Practice Address - Country:US
Practice Address - Phone:407-677-8881
Practice Address - Fax:407-677-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70848OtherBCBS
FLE7299OtherMEDICARE P-TAN
FL70848OtherBCBS