Provider Demographics
NPI:1902810815
Name:FLORIDA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FLORIDA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-878-6500
Mailing Address - Street 1:1944 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5510
Mailing Address - Country:US
Mailing Address - Phone:772-878-6500
Mailing Address - Fax:772-878-6501
Practice Address - Street 1:1944 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5510
Practice Address - Country:US
Practice Address - Phone:772-878-6500
Practice Address - Fax:772-878-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007060111N00000X
FLCH7659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53937Medicare ID - Type Unspecified
FL55396AMedicare ID - Type Unspecified