Provider Demographics
NPI:1083611404
Name:MCTUREOUS, ERIC WILSON (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILSON
Last Name:MCTUREOUS
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 1:5709 SW 75TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5504
Mailing Address - Country:US
Mailing Address - Phone:352-364-8780
Mailing Address - Fax:352-336-5325
Practice Address - Street 1:5709 SW 75TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5504
Practice Address - Country:US
Practice Address - Phone:352-364-8780
Practice Address - Fax:352-336-5325
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04424Medicare UPIN
FL88523ZMedicare PIN