Provider Demographics
NPI:1386923282
Name:DEMETREE CHIROPRACTIC GROUP, INC.
Entity type:Organization
Organization Name:DEMETREE CHIROPRACTIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMETREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-977-7233
Mailing Address - Street 1:1750 W BROADWAY ST
Mailing Address - Street 2:STE# 108
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9618
Mailing Address - Country:US
Mailing Address - Phone:407-977-7233
Mailing Address - Fax:407-359-6822
Practice Address - Street 1:1750 W BROADWAY ST
Practice Address - Street 2:STE# 108
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9618
Practice Address - Country:US
Practice Address - Phone:407-977-7233
Practice Address - Fax:407-359-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6994261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55400OtherBCBS
FL38-0922600Medicaid
FL55400OtherBCBS
FL38-0922600Medicaid