Provider Demographics
NPI:1194031732
Name:W. PATRICK DANZEY, D.C.P.A.
Entity Type:Organization
Organization Name:W. PATRICK DANZEY, D.C.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DANZEY
Authorized Official - Suffix:
Authorized Official - Credentials:DCPA
Authorized Official - Phone:863-453-5777
Mailing Address - Street 1:1590 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2151
Mailing Address - Country:US
Mailing Address - Phone:863-453-5777
Mailing Address - Fax:863-453-9737
Practice Address - Street 1:1590 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2151
Practice Address - Country:US
Practice Address - Phone:863-453-5777
Practice Address - Fax:863-453-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002887000Medicaid
FLT94417Medicare UPIN
FL6178730001Medicare NSC
FL002887000Medicaid