Provider Demographics
NPI:1144386897
Name:PEACHLAND CHIROPRACTIC HEALTH LLC
Entity Type:Organization
Organization Name:PEACHLAND CHIROPRACTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-255-0424
Mailing Address - Street 1:24150 TISEO BLVD
Mailing Address - Street 2:UNIT #4
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-5230
Mailing Address - Country:US
Mailing Address - Phone:941-255-0424
Mailing Address - Fax:941-255-0428
Practice Address - Street 1:24150 TISEO BLVD
Practice Address - Street 2:UNIT #4
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5230
Practice Address - Country:US
Practice Address - Phone:941-255-0424
Practice Address - Fax:941-255-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54998Medicare UPIN