Provider Demographics
NPI:1033243357
Name:FLORIDA CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:FLORIDA CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BELION
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:850-784-6075
Mailing Address - Street 1:6029 E HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7488
Mailing Address - Country:US
Mailing Address - Phone:850-784-6075
Mailing Address - Fax:850-784-9422
Practice Address - Street 1:6029 E HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-7488
Practice Address - Country:US
Practice Address - Phone:850-784-6075
Practice Address - Fax:850-784-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381110700Medicaid
FL55777Medicare PIN
FL6262830001Medicare NSC