Provider Demographics
NPI:1730418591
Name:JOHN ABENDROTH, D.C., P.A.
Entity type:Organization
Organization Name:JOHN ABENDROTH, D.C., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ABENDROTH
Authorized Official - Suffix:III
Authorized Official - Credentials:DC PA
Authorized Official - Phone:772-223-7337
Mailing Address - Street 1:2100 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3332
Mailing Address - Country:US
Mailing Address - Phone:772-223-7337
Mailing Address - Fax:772-223-7794
Practice Address - Street 1:2100 SE OCEAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-223-7337
Practice Address - Fax:772-223-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH7777Medicare UPIN
FL6627220001Medicare NSC
FLDQ805AMedicare PIN
FL55897Medicare PIN