Provider Demographics
NPI:1073519864
Name:FLAGLER CHIROPRACTIC PA
Entity Type:Organization
Organization Name:FLAGLER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEMNOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-439-9001
Mailing Address - Street 1:1240 SOUTH AIA
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136
Mailing Address - Country:US
Mailing Address - Phone:386-439-9001
Mailing Address - Fax:386-439-9002
Practice Address - Street 1:1240 SOUTH AIA
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136
Practice Address - Country:US
Practice Address - Phone:386-439-9001
Practice Address - Fax:386-439-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22770OtherBCBS
U22334Medicare UPIN
FL22770Medicare ID - Type Unspecified