Provider Demographics
NPI:1063446292
Name:MACHARA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MACHARA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-479-6429
Mailing Address - Street 1:1643 STARGAZER TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9298
Mailing Address - Country:US
Mailing Address - Phone:386-479-6429
Mailing Address - Fax:
Practice Address - Street 1:1643 STARGAZER TER
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9298
Practice Address - Country:US
Practice Address - Phone:386-479-6429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22304OtherBLUE CROSS BLUE SHIELD
FL350055647OtherRAILROAD MEDICARE
FL22304Medicare ID - Type Unspecified