Provider Demographics
NPI:1073567582
Name:KUCHARIK, EDWARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KUCHARIK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3641
Mailing Address - Country:US
Mailing Address - Phone:727-393-8700
Mailing Address - Fax:727-393-8770
Practice Address - Street 1:13035 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3641
Practice Address - Country:US
Practice Address - Phone:727-393-8700
Practice Address - Fax:727-393-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70720OtherBLUE CROSS/ BLUE SHIELD
FL70720OtherBLUE CROSS/ BLUE SHIELD
FLU20410Medicare UPIN