Provider Demographics
NPI:1023552395
Name:TROUBLE CREEK CHIROPRACTIC
Entity Type:Organization
Organization Name:TROUBLE CREEK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:727-807-5258
Mailing Address - Street 1:4515 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4755
Mailing Address - Country:US
Mailing Address - Phone:727-807-5258
Mailing Address - Fax:727-807-7644
Practice Address - Street 1:4515 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4755
Practice Address - Country:US
Practice Address - Phone:727-807-5258
Practice Address - Fax:727-807-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty