Provider Demographics
NPI:1033430921
Name:JOHN C THEECK DC PA
Entity Type:Organization
Organization Name:JOHN C THEECK DC PA
Other - Org Name:LEGACY CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THEECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-775-2068
Mailing Address - Street 1:1950 LAUREL MANOR DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5603
Mailing Address - Country:US
Mailing Address - Phone:352-259-0024
Mailing Address - Fax:
Practice Address - Street 1:1950 LAUREL MANOR DR
Practice Address - Street 2:SUITE 204
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5603
Practice Address - Country:US
Practice Address - Phone:352-259-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty