Provider Demographics
NPI:1205822020
Name:CHIROPRACTIC EXPRESS INC
Entity Type:Organization
Organization Name:CHIROPRACTIC EXPRESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-458-8800
Mailing Address - Street 1:1526 SE 16TH PL STE B
Mailing Address - Street 2:#B
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3831
Mailing Address - Country:US
Mailing Address - Phone:239-458-8800
Mailing Address - Fax:239-458-5291
Practice Address - Street 1:1526 SE 16TH PL STE B
Practice Address - Street 2:#B
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3831
Practice Address - Country:US
Practice Address - Phone:239-458-8800
Practice Address - Fax:239-458-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70097OtherBLUE CROSS BLUE SHIELD
FL70097OtherBLUE CROSS BLUE SHIELD
FLU90195Medicare UPIN