Provider Demographics
NPI:1518275072
Name:WESTBROOK CHIROPRACTIC PL
Entity Type:Organization
Organization Name:WESTBROOK CHIROPRACTIC PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-685-6202
Mailing Address - Street 1:PO BOX 5122
Mailing Address - Street 2:
Mailing Address - City:SALT SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32134-5122
Mailing Address - Country:US
Mailing Address - Phone:352-685-6202
Mailing Address - Fax:
Practice Address - Street 1:14100 N HIGHWAY 19 STE B
Practice Address - Street 2:
Practice Address - City:SALT SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32134-8632
Practice Address - Country:US
Practice Address - Phone:352-685-2467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty