1215199617 NPI number — MANATEE MEDICAL MASSAGE & CHIROPRACTIC, INC.

Table of content: MRS. CHRISTA TERESE PILLADO LVN (NPI 1386879740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215199617 NPI number — MANATEE MEDICAL MASSAGE & CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANATEE MEDICAL MASSAGE & CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215199617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2823 US HIGHWAY 301 N
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
ELLENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34222-2084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-723-1908
Provider Business Mailing Address Fax Number:
941-723-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2823 US HIGHWAY 301 N
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ELLENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34222-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-723-1908
Provider Business Practice Location Address Fax Number:
941-723-1303
Provider Enumeration Date:
06/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SUTPHIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER/PRESIDENT/DIRECTOR
Authorized Official Telephone Number:
941-723-1908

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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