Provider Demographics
NPI:1205021086
Name:CHIROPRACTIC CLINICS, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-736-1000
Mailing Address - Street 1:516 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7813
Mailing Address - Country:US
Mailing Address - Phone:727-736-1000
Mailing Address - Fax:727-736-3556
Practice Address - Street 1:516 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7813
Practice Address - Country:US
Practice Address - Phone:727-736-1000
Practice Address - Fax:727-736-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3477Medicare PIN