Provider Demographics
NPI:1114030400
Name:PODLASKI, JOHN ANDREW (DC, DACBN,DABCI)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:PODLASKI
Suffix:
Gender:M
Credentials:DC, DACBN,DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0710
Mailing Address - Country:US
Mailing Address - Phone:352-414-9998
Mailing Address - Fax:352-867-1015
Practice Address - Street 1:2721 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0710
Practice Address - Country:US
Practice Address - Phone:352-414-9998
Practice Address - Fax:352-867-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4801111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBG080ZOtherMEDICARE
FL55690OtherBCBS