Provider Demographics
NPI:1912504663
Name:SEASIDE CHIROPRACTIC HOUSE CALLS
Entity type:Organization
Organization Name:SEASIDE CHIROPRACTIC HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATOLI-HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-269-6680
Mailing Address - Street 1:4658 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4319
Mailing Address - Country:US
Mailing Address - Phone:386-269-6680
Mailing Address - Fax:
Practice Address - Street 1:1331 SAXON DR # 147
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3160
Practice Address - Country:US
Practice Address - Phone:386-269-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty