Provider Demographics
NPI:1225245392
Name:EAST BAY ACCIDENT & WELLNESS CENTER
Entity Type:Organization
Organization Name:EAST BAY ACCIDENT & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-581-2774
Mailing Address - Street 1:800 EAST BAY DRIVE STE P
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2554
Mailing Address - Country:US
Mailing Address - Phone:727-581-2774
Mailing Address - Fax:727-581-3199
Practice Address - Street 1:800 E BAY DR STE P
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2554
Practice Address - Country:US
Practice Address - Phone:727-581-2774
Practice Address - Fax:727-581-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty