Provider Demographics
NPI:1184661449
Name:SHEMANSKY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:SHEMANSKY CHIROPRACTIC, P.A.
Other - Org Name:GULFSHORE CHIROPRACTIC CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-948-5727
Mailing Address - Street 1:24830 BURNT PINE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1974
Mailing Address - Country:US
Mailing Address - Phone:239-948-5727
Mailing Address - Fax:888-657-4642
Practice Address - Street 1:24830 BURNT PINE DR STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1974
Practice Address - Country:US
Practice Address - Phone:239-948-5727
Practice Address - Fax:888-657-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-8023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53933OtherBCBS
FL53933OtherBCBS ID
FL10720888Medicaid
FLU83774Medicare UPIN
FL53933OtherBCBS ID
FLK9886Medicare ID - Type UnspecifiedFACILITY ID