Provider Demographics
NPI:1316254063
Name:MARKLAND CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:MARKLAND CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-793-3337
Mailing Address - Street 1:116 N COUNTY ROAD 470
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-6048
Mailing Address - Country:US
Mailing Address - Phone:352-793-3337
Mailing Address - Fax:352-793-3337
Practice Address - Street 1:116 N COUNTY ROAD 470
Practice Address - Street 2:
Practice Address - City:LAKE PANASOFFKEE
Practice Address - State:FL
Practice Address - Zip Code:33538-6048
Practice Address - Country:US
Practice Address - Phone:352-793-3337
Practice Address - Fax:352-793-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU13569Medicare UPIN