Provider Demographics
NPI:1164568796
Name:CONFORTI'S CROSSROADS CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CONFORTI'S CROSSROADS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BODANZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-376-9611
Mailing Address - Street 1:1811 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5363
Mailing Address - Country:US
Mailing Address - Phone:727-376-9611
Mailing Address - Fax:727-376-0752
Practice Address - Street 1:1811 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5363
Practice Address - Country:US
Practice Address - Phone:727-376-9611
Practice Address - Fax:727-376-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8344Medicare ID - Type Unspecified