Provider Demographics
NPI:1316260474
Name:MITCHELL KAPLAN DC PA
Entity type:Organization
Organization Name:MITCHELL KAPLAN DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-255-3003
Mailing Address - Street 1:PO BOX 360914
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0914
Mailing Address - Country:US
Mailing Address - Phone:321-255-3003
Mailing Address - Fax:321-255-3005
Practice Address - Street 1:1565 SARNO RD STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5268
Practice Address - Country:US
Practice Address - Phone:321-255-3003
Practice Address - Fax:321-255-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380957900Medicaid
FL1205832862OtherNPI
FL1205832862OtherNPI
FL380957900Medicaid