Provider Demographics
NPI:1255504833
Name:CHEATWOOD, CLIFFORD GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:GREGORY
Last Name:CHEATWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6432 LONGWOOD TRACE LN N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3115
Mailing Address - Country:US
Mailing Address - Phone:863-644-3040
Mailing Address - Fax:
Practice Address - Street 1:6432 LONGWOOD TRACE LN N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3115
Practice Address - Country:US
Practice Address - Phone:863-644-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor