Basic Information
| Provider Information | |||||||||
| NPI: | 1447446828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIRO-MED HEALTH AND REHAB PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12479 S ACCESS RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339816206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416973001 | ||||||||
| FaxNumber: | 9416973003 | ||||||||
| Practice Location | |||||||||
| Address1: | 12479 S ACCESS RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339816206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416973001 | ||||||||
| FaxNumber: | 9416973003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
| AuthorizedOfficialMiddleName: | NOEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9416973001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH8838 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.