Provider Demographics
NPI:1255663548
Name:IMMOKALEE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:IMMOKALEE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-297-7737
Mailing Address - Street 1:13260 IMMOKALEE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1788
Mailing Address - Country:US
Mailing Address - Phone:239-297-7737
Mailing Address - Fax:239-303-1839
Practice Address - Street 1:13260 IMMOKALEE RD STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-1788
Practice Address - Country:US
Practice Address - Phone:239-297-7737
Practice Address - Fax:239-303-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7675261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH-7675OtherCHIROPRACTOR LICENSE