1588263867 NPI number — ORCHID ISLAND CHIROPRACTIC, LLC

Table of content: (NPI 1588263867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588263867 NPI number — ORCHID ISLAND CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORCHID ISLAND CHIROPRACTIC, LLC
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:
1588263867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5056 5TH MNR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32968-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-766-3311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9613 N US HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBASTIAN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32958-6363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-766-3311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
772-766-3311

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)

  • Identifier: 1801193818 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com