Provider Demographics
NPI:1366504003
Name:ORANGE PARK CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:ORANGE PARK CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SCHERTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-272-4555
Mailing Address - Street 1:868 BLANDING BLVD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8942
Mailing Address - Country:US
Mailing Address - Phone:904-272-4555
Mailing Address - Fax:904-276-2521
Practice Address - Street 1:868 BLANDING BLVD
Practice Address - Street 2:SUITE 128
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-272-4555
Practice Address - Fax:904-276-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381197200Medicaid
FLE4313ZMedicare ID - Type Unspecified
FL381197200Medicaid