Provider Demographics
NPI:1265457147
Name:DR PEPPER CHIROPRACTIC-ACUPUNCTURE CENTER INC
Entity Type:Organization
Organization Name:DR PEPPER CHIROPRACTIC-ACUPUNCTURE CENTER INC
Other - Org Name:AFFINITY HEALTH PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:863-386-4325
Mailing Address - Street 1:2827 ALT. HWY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870
Mailing Address - Country:US
Mailing Address - Phone:863-386-4325
Mailing Address - Fax:863-386-0473
Practice Address - Street 1:2827 ALT. HWY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-386-4325
Practice Address - Fax:863-386-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55754ZMedicare ID - Type Unspecified