Provider Demographics
NPI:1407929557
Name:OCEAN CHIROPRACTIC & HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:OCEAN CHIROPRACTIC & HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-460-9000
Mailing Address - Street 1:805 VIRGINIA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5881
Mailing Address - Country:US
Mailing Address - Phone:772-460-9000
Mailing Address - Fax:772-460-6697
Practice Address - Street 1:805 VIRGINIA AVE STE 10
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5881
Practice Address - Country:US
Practice Address - Phone:772-460-9000
Practice Address - Fax:772-460-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7211Medicare ID - Type Unspecified