Provider Demographics
NPI:1164782553
Name:PERDUE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:PERDUE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TWOHIG
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:321-984-5355
Mailing Address - Street 1:1900 PALM BAY RD NE STE E
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2955
Mailing Address - Country:US
Mailing Address - Phone:321-984-5355
Mailing Address - Fax:321-984-7206
Practice Address - Street 1:1900 PALM BAY RD NE STE E
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2955
Practice Address - Country:US
Practice Address - Phone:321-984-5355
Practice Address - Fax:321-984-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty