Provider Demographics
NPI:1699936138
Name:DAVID CHIROPRACTIC LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DAVID CHIROPRACTIC LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-388-8788
Mailing Address - Street 1:1623 US HIGHWAY 1 STE B6
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3879
Mailing Address - Country:US
Mailing Address - Phone:772-388-8788
Mailing Address - Fax:772-388-8819
Practice Address - Street 1:1623 US HIGHWAY 1 STE B6
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3879
Practice Address - Country:US
Practice Address - Phone:772-388-8788
Practice Address - Fax:772-388-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3399111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88511AMedicare PIN