Provider Demographics
NPI:1083231401
Name:DISHMAN CHIROPRACTIC AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:DISHMAN CHIROPRACTIC AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:DISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-939-1010
Mailing Address - Street 1:606 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747
Mailing Address - Country:US
Mailing Address - Phone:321-939-1010
Mailing Address - Fax:321-900-4563
Practice Address - Street 1:606 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:321-939-1010
Practice Address - Fax:321-900-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty