Provider Demographics
NPI:1396996963
Name:COUNTRYSIDE CHIROPRACTIC INC
Entity type:Organization
Organization Name:COUNTRYSIDE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIUSEPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVATTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:727-723-3888
Mailing Address - Street 1:28469 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2512
Mailing Address - Country:US
Mailing Address - Phone:727-723-3888
Mailing Address - Fax:727-796-2888
Practice Address - Street 1:28469 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 402
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2512
Practice Address - Country:US
Practice Address - Phone:727-723-3888
Practice Address - Fax:727-796-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty