Provider Demographics
NPI:1114288842
Name:CROTON CHIROPRACTIC CLINIC P. A.
Entity Type:Organization
Organization Name:CROTON CHIROPRACTIC CLINIC P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAUENHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-961-4359
Mailing Address - Street 1:2025 W EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4085
Mailing Address - Country:US
Mailing Address - Phone:321-961-4359
Mailing Address - Fax:
Practice Address - Street 1:2025 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4085
Practice Address - Country:US
Practice Address - Phone:321-961-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty