Provider Demographics
NPI:1366611378
Name:S AND S UNITED 'LLC'
Entity type:Organization
Organization Name:S AND S UNITED 'LLC'
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SERGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-597-4915
Mailing Address - Street 1:4869 PALM COAST PKWY NW
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3661
Mailing Address - Country:US
Mailing Address - Phone:386-597-4915
Mailing Address - Fax:386-597-4953
Practice Address - Street 1:4869 PALM COAST PKWY NW
Practice Address - Street 2:SUITE #1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3661
Practice Address - Country:US
Practice Address - Phone:386-597-4915
Practice Address - Fax:386-597-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty