Provider Demographics
NPI:1023181773
Name:CHIROPRACTIC INJURY AND RECOVERY CENTER INC
Entity Type:Organization
Organization Name:CHIROPRACTIC INJURY AND RECOVERY CENTER INC
Other - Org Name:CHIRORECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-755-1581
Mailing Address - Street 1:4705 26TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1704
Mailing Address - Country:US
Mailing Address - Phone:941-755-1581
Mailing Address - Fax:
Practice Address - Street 1:4705 26TH ST W
Practice Address - Street 2:STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1704
Practice Address - Country:US
Practice Address - Phone:941-755-1581
Practice Address - Fax:941-758-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5993Medicare ID - Type Unspecified