Provider Demographics
NPI:1235458720
Name:SEACOAST CLINIC OF CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SEACOAST CLINIC OF CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISLOCKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-418-1551
Mailing Address - Street 1:149 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5017
Mailing Address - Country:US
Mailing Address - Phone:772-621-7777
Mailing Address - Fax:772-621-3825
Practice Address - Street 1:149 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5017
Practice Address - Country:US
Practice Address - Phone:772-621-7777
Practice Address - Fax:772-621-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty