Provider Demographics
NPI:1225433782
Name:GEN TRIO, PA
Entity Type:Organization
Organization Name:GEN TRIO, PA
Other - Org Name:ACTIVE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-344-4499
Mailing Address - Street 1:9654 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1805
Mailing Address - Country:US
Mailing Address - Phone:813-344-4499
Mailing Address - Fax:
Practice Address - Street 1:9654 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1805
Practice Address - Country:US
Practice Address - Phone:813-344-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty