Provider Demographics
NPI:1396263331
Name:ESSENTIAL CHIROPRACTIC PA
Entity type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYELLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, AO PROVIDER
Authorized Official - Phone:239-300-0885
Mailing Address - Street 1:6308 TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2836
Mailing Address - Country:US
Mailing Address - Phone:239-300-0885
Mailing Address - Fax:
Practice Address - Street 1:6308 TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2836
Practice Address - Country:US
Practice Address - Phone:239-530-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty