Provider Demographics
NPI:1831430313
Name:CHIROPRACTIC CARE OF SW FL PA
Entity type:Organization
Organization Name:CHIROPRACTIC CARE OF SW FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-362-0342
Mailing Address - Street 1:3509 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-0925
Mailing Address - Country:US
Mailing Address - Phone:239-362-0342
Mailing Address - Fax:239-362-0348
Practice Address - Street 1:3509 FOWLER ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-0925
Practice Address - Country:US
Practice Address - Phone:239-362-0342
Practice Address - Fax:239-362-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7088261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center