Provider Demographics
NPI:1497026587
Name:SECONI FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SECONI FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SECONI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-341-3111
Mailing Address - Street 1:2220 HIGHWAY 44 W
Mailing Address - Street 2:SUITE C2
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3860
Mailing Address - Country:US
Mailing Address - Phone:352-341-3111
Mailing Address - Fax:352-341-3123
Practice Address - Street 1:2220 HIGHWAY 44 W
Practice Address - Street 2:SUITE C2
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3860
Practice Address - Country:US
Practice Address - Phone:352-341-3111
Practice Address - Fax:352-341-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU56109Medicare UPIN
FL55279Medicare PIN