Provider Demographics
NPI:1235193509
Name:DUKES CHIROPRACTIC HEALTH CLINIC, P.A.
Entity Type:Organization
Organization Name:DUKES CHIROPRACTIC HEALTH CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-752-2524
Mailing Address - Street 1:2401 WALDEN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-7172
Mailing Address - Country:US
Mailing Address - Phone:813-752-2524
Mailing Address - Fax:813-754-4967
Practice Address - Street 1:2401 WALDEN WOODS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-7172
Practice Address - Country:US
Practice Address - Phone:813-752-2524
Practice Address - Fax:813-754-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4717111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85459Medicare UPIN
70579Medicare ID - Type Unspecified