Provider Demographics
NPI:1548383268
Name:COLLEGE PARKWAY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:COLLEGE PARKWAY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGENFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-437-4000
Mailing Address - Street 1:6371 PRESIDENTIAL CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3544
Mailing Address - Country:US
Mailing Address - Phone:239-437-4000
Mailing Address - Fax:239-437-4003
Practice Address - Street 1:6371 PRESIDENTIAL CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3544
Practice Address - Country:US
Practice Address - Phone:239-437-4000
Practice Address - Fax:239-437-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty