Provider Demographics
NPI:1285330605
Name:RESTORATION FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:RESTORATION FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MCRAE
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-528-1134
Mailing Address - Street 1:3831 TYRONE BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4114
Mailing Address - Country:US
Mailing Address - Phone:727-440-2770
Mailing Address - Fax:727-256-0344
Practice Address - Street 1:3831 TYRONE BLVD N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4114
Practice Address - Country:US
Practice Address - Phone:847-528-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty