Provider Demographics
NPI:1346642402
Name:THE FIT CHIRO LLC
Entity type:Organization
Organization Name:THE FIT CHIRO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-641-0960
Mailing Address - Street 1:3380 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1539
Mailing Address - Country:US
Mailing Address - Phone:727-258-4886
Mailing Address - Fax:727-258-4888
Practice Address - Street 1:3380 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1539
Practice Address - Country:US
Practice Address - Phone:727-258-4886
Practice Address - Fax:727-258-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty