Provider Demographics
NPI:1992992770
Name:LATORRE CHIROPRACTIC, INC
Entity type:Organization
Organization Name:LATORRE CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WLILIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-321-6130
Mailing Address - Street 1:2150 49TH ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5237
Mailing Address - Country:US
Mailing Address - Phone:727-321-6130
Mailing Address - Fax:727-327-2677
Practice Address - Street 1:2150 49TH ST N
Practice Address - Street 2:SUITE C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5237
Practice Address - Country:US
Practice Address - Phone:727-321-6130
Practice Address - Fax:727-327-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38125100Medicaid
FL38125100Medicaid