Provider Demographics
NPI:1427372093
Name:STEELE CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:STEELE CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:DAVENPORT
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-362-4112
Mailing Address - Street 1:P.O. BOX 487
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-362-4112
Mailing Address - Fax:386-208-0418
Practice Address - Street 1:609 5TH STREET S.W.
Practice Address - Street 2:SUITE 3
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064
Practice Address - Country:US
Practice Address - Phone:386-362-4112
Practice Address - Fax:386-208-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55218OtherBLUE CROSS
FL55218ZOtherBLUE CROSS (FL)
FL380713400Medicaid
FL53427Medicare UPIN
FL380713400Medicaid