Provider Demographics
NPI:1316010143
Name:CONFORTI CHIROPRACTIC & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:CONFORTI CHIROPRACTIC & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-818-7499
Mailing Address - Street 1:4040 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3205
Mailing Address - Country:US
Mailing Address - Phone:813-818-7499
Mailing Address - Fax:813-818-7239
Practice Address - Street 1:4040 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3205
Practice Address - Country:US
Practice Address - Phone:813-818-7499
Practice Address - Fax:813-818-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002847800Medicaid
FL002847800Medicaid