Provider Demographics
NPI:1164065439
Name:SCANDY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SCANDY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANDALIARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-754-3879
Mailing Address - Street 1:750 N BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2138
Mailing Address - Country:US
Mailing Address - Phone:727-754-3879
Mailing Address - Fax:
Practice Address - Street 1:750 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2138
Practice Address - Country:US
Practice Address - Phone:727-754-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty