Provider Demographics
NPI:1528384880
Name:CRACK IT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CRACK IT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-650-9453
Mailing Address - Street 1:1196 JONAH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9492
Mailing Address - Country:US
Mailing Address - Phone:941-650-9453
Mailing Address - Fax:
Practice Address - Street 1:531 TAMIAMI TRL
Practice Address - Street 2:UNIT 5
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-2199
Practice Address - Country:US
Practice Address - Phone:941-650-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty