Provider Demographics
NPI:1073568572
Name:CHIROMED CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:CHIROMED CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGELSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-5500
Mailing Address - Street 1:PO BOX 15639
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2339
Mailing Address - Country:US
Mailing Address - Phone:912-354-5500
Mailing Address - Fax:912-355-1848
Practice Address - Street 1:205 WEST BUSH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:800-679-7246
Practice Address - Fax:912-355-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55388YMedicare ID - Type UnspecifiedCHIROPRACTOR
FL88747ZMedicare ID - Type UnspecifiedCHIROPRACTOR
FL89403ZMedicare ID - Type UnspecifiedCHIROPRACTOR
FL22117ZMedicare ID - Type UnspecifiedCHRIOPRACTOR
FL89997ZMedicare ID - Type UnspecifiedCHIROPRACTOR
FL22788YMedicare ID - Type UnspecifiedCHIROPRACTOR
FL53934YMedicare ID - Type UnspecifiedCHIROPRACTOR
FLE4653VMedicare ID - Type UnspecifiedCHIROPRACTOR
FL71485ZMedicare ID - Type UnspecifiedCHIROPRACTOR