Provider Demographics
NPI:1356617955
Name:HOLISTIC INSTITUTE OF SO. FL, INC
Entity type:Organization
Organization Name:HOLISTIC INSTITUTE OF SO. FL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-641-7997
Mailing Address - Street 1:2480 SO. CONGRESS AVE.
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7615
Mailing Address - Country:US
Mailing Address - Phone:561-641-7997
Mailing Address - Fax:561-641-2461
Practice Address - Street 1:2480 SO. CONGRESS AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7615
Practice Address - Country:US
Practice Address - Phone:561-641-7997
Practice Address - Fax:561-641-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T56236Medicare UPIN