Provider Demographics
NPI:1538492046
Name:FIELDING CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:FIELDING CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:VERL
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-751-1147
Mailing Address - Street 1:5314 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-3011
Mailing Address - Country:US
Mailing Address - Phone:941-751-1147
Mailing Address - Fax:941-751-6952
Practice Address - Street 1:5314 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3011
Practice Address - Country:US
Practice Address - Phone:941-751-1147
Practice Address - Fax:941-751-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9647261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center