Provider Demographics
NPI:1912318601
Name:UNDERHILL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:UNDERHILL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:386-690-0816
Mailing Address - Street 1:314 CITRUS OPEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6194
Mailing Address - Country:US
Mailing Address - Phone:334-655-8455
Mailing Address - Fax:
Practice Address - Street 1:401 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7009
Practice Address - Country:US
Practice Address - Phone:386-690-0816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty