Provider Demographics
NPI:1417597667
Name:IMAC MANAGEMENT OF FLORIDA, LLC
Entity Type:Organization
Organization Name:IMAC MANAGEMENT OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:615-889-0024
Mailing Address - Street 1:1605 WESTGATE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8396
Mailing Address - Country:US
Mailing Address - Phone:615-889-0024
Mailing Address - Fax:
Practice Address - Street 1:24830 S TAMIAMI TRL STE 1000
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7031
Practice Address - Country:US
Practice Address - Phone:239-948-3280
Practice Address - Fax:239-236-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH7358OtherSTATE CHIROPRACTIC LICENSE