1255476230 NPI number — PELUSO CHIROPRACTIC CENTER PA

Table of content: (NPI 1255476230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255476230 NPI number — PELUSO CHIROPRACTIC CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PELUSO CHIROPRACTIC CENTER PA
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:
1255476230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36949 US HIGHWAY 19 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34684-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-934-7602
Provider Business Mailing Address Fax Number:
727-934-7704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36949 US HIGHWAY 19 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34684-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-934-7602
Provider Business Practice Location Address Fax Number:
727-934-7704
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLY
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-934-7602

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  CH5006 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: CH 5006 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X , with the licence number: CH 5006 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0554294-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".