Provider Demographics
NPI:1730334632
Name:CHIROPRACTIC HEALTH CENTER INC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GADOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-854-1177
Mailing Address - Street 1:230 PINE AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4677
Mailing Address - Country:US
Mailing Address - Phone:813-854-1177
Mailing Address - Fax:813-855-2215
Practice Address - Street 1:230 PINE AVE N STE B
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4677
Practice Address - Country:US
Practice Address - Phone:813-854-1177
Practice Address - Fax:813-855-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3811051-00Medicaid
FL22562OtherBCBS
FL22562Medicare PIN
FL22562OtherBCBS