Provider Demographics
NPI:1962724740
Name:SCOMA CHIROPRACTIC,P.A.
Entity type:Organization
Organization Name:SCOMA CHIROPRACTIC,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-945-1717
Mailing Address - Street 1:3714 DEL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-945-1717
Mailing Address - Fax:239-945-1963
Practice Address - Street 1:3714 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7135
Practice Address - Country:US
Practice Address - Phone:239-945-1717
Practice Address - Fax:239-945-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93981Medicare UPIN
FL22033Medicare PIN