Provider Demographics
NPI:1801427638
Name:CHIROPRACTIC & LONGEVITY CENTER LLC
Entity type:Organization
Organization Name:CHIROPRACTIC & LONGEVITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-315-1178
Mailing Address - Street 1:601 E. ELKAM CIRCLE UNIT B-11
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145
Mailing Address - Country:US
Mailing Address - Phone:239-315-1178
Mailing Address - Fax:
Practice Address - Street 1:601 E. ELKAM CIRCLE UNIT B-11
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145
Practice Address - Country:US
Practice Address - Phone:239-315-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty