1932207206 NPI number — BACK-2-LIFE OF FLORIDEA

Table of content: (NPI 1932207206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932207206 NPI number — BACK-2-LIFE OF FLORIDEA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK-2-LIFE OF FLORIDEA
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:
1932207206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2905 RIGSBY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAFETY HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34695-4828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-797-0500
Provider Business Mailing Address Fax Number:
727-797-0050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2905 RIGSBY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAFETY HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34695-4828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-797-0500
Provider Business Practice Location Address Fax Number:
727-797-0050
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROTEKE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIROPRACTOR PHYSICIAN
Authorized Official Telephone Number:
727-797-0500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9772 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 171000000X , with the licence number: ME 97457 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 99652 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1447270566 . This is a "GROTEKE NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9067913 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1147626 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9067913 . This is a "DR. ERIC GROTEKE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 71494 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME97457 . This is a "RHODES LICENSE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1038157 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 656080 . This is a "ACN GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CH8146 . This is a "STAFFORD'S LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1750349301 . This is a "RHODES NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1770650574 . This is a "STAFFORD'S NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 656080 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CH8772 . This is a "GROTEKE'S LICENSE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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