Provider Demographics
NPI:1134307291
Name:TAMPA CHIROPRACTIC AND REHAB CENTER INC.
Entity Type:Organization
Organization Name:TAMPA CHIROPRACTIC AND REHAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MARCIAL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-801-9001
Mailing Address - Street 1:4023 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1017
Mailing Address - Country:US
Mailing Address - Phone:813-801-9001
Mailing Address - Fax:813-801-9007
Practice Address - Street 1:4023 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1017
Practice Address - Country:US
Practice Address - Phone:813-801-9001
Practice Address - Fax:813-801-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8456261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation