Provider Demographics
NPI:1528318003
Name:HARVEY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HARVEY CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:SOURS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-627-0095
Mailing Address - Street 1:3417 TAMIAMI TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8158
Mailing Address - Country:US
Mailing Address - Phone:941-627-0095
Mailing Address - Fax:941-629-1872
Practice Address - Street 1:3417 TAMIAMI TRL
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-627-0095
Practice Address - Fax:941-629-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL732AMedicare PIN
FLGL984ZMedicare PIN