Provider Demographics
NPI:1245426733
Name:CORRECTIVE CARE CHIROPRACTIC LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CORRECTIVE CARE CHIROPRACTIC LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-752-6002
Mailing Address - Street 1:4517 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1295
Mailing Address - Country:US
Mailing Address - Phone:941-752-6002
Mailing Address - Fax:941-752-6008
Practice Address - Street 1:4517 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1295
Practice Address - Country:US
Practice Address - Phone:941-752-6002
Practice Address - Fax:941-752-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6440Medicare PIN