Provider Demographics
NPI:1255476230
Name:PELUSO CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:PELUSO CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-934-7602
Mailing Address - Street 1:36949 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1238
Mailing Address - Country:US
Mailing Address - Phone:727-934-7602
Mailing Address - Fax:727-934-7704
Practice Address - Street 1:36949 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1238
Practice Address - Country:US
Practice Address - Phone:727-934-7602
Practice Address - Fax:727-934-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5006261QH0100X
FLCH 5006261QP2300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0554294-00Medicaid
FLT94470Medicare UPIN
FL0554294-00Medicaid