Provider Demographics
NPI:1346306271
Name:SUNCOAST CHIROPRACTIC AND ACUPUNCTURE PA
Entity Type:Organization
Organization Name:SUNCOAST CHIROPRACTIC AND ACUPUNCTURE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-743-9904
Mailing Address - Street 1:PO BOX 380236
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0236
Mailing Address - Country:US
Mailing Address - Phone:941-743-9904
Mailing Address - Fax:941-743-9905
Practice Address - Street 1:687 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-2903
Practice Address - Country:US
Practice Address - Phone:941-743-9904
Practice Address - Fax:941-743-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD328Medicare PIN