Provider Demographics
NPI:1306856034
Name:ALVAREZ FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALVAREZ FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-734-2522
Mailing Address - Street 1:141 E INDIANA AV
Mailing Address - Street 2:STE B
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4329
Mailing Address - Country:US
Mailing Address - Phone:386-734-2522
Mailing Address - Fax:386-734-2502
Practice Address - Street 1:141 E INDIANA AV
Practice Address - Street 2:STE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4329
Practice Address - Country:US
Practice Address - Phone:386-734-2522
Practice Address - Fax:386-734-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7957111N00000X
FLCH7642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAO988ZOtherMEDICARE PTAN
FL381396700Medicaid
FL53880OtherBLUE CROSS BLUE SHIELD
FLAO971ZOtherMEDICARE PTAN
FL55935OtherBLUE CROSS BLUE SHIELD
FL381395900Medicaid
FL381396700Medicaid
FL381395900Medicaid
FLAO971ZOtherMEDICARE PTAN