Provider Demographics
NPI:1437147915
Name:FAMILY LIFE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:FAMILY LIFE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-447-4647
Mailing Address - Street 1:205 N GARDEN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4124
Mailing Address - Country:US
Mailing Address - Phone:727-447-4647
Mailing Address - Fax:727-443-3195
Practice Address - Street 1:205 N GARDEN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4124
Practice Address - Country:US
Practice Address - Phone:727-447-4647
Practice Address - Fax:727-443-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39185Medicare PIN