Provider Demographics
NPI:1275835399
Name:PLATT CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:PLATT CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-763-2400
Mailing Address - Street 1:280 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5918
Mailing Address - Country:US
Mailing Address - Phone:863-763-2400
Mailing Address - Fax:863-763-2446
Practice Address - Street 1:280 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5918
Practice Address - Country:US
Practice Address - Phone:863-763-2400
Practice Address - Fax:863-763-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380505100Medicaid
FL22672OtherBCBS
FLU20801Medicare UPIN
FL380505100Medicaid