Provider Demographics
NPI:1548580566
Name:VANDERBECK CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:VANDERBECK CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-627-0095
Mailing Address - Street 1:2751 TAMIAMI TRL STE C
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5170
Mailing Address - Country:US
Mailing Address - Phone:941-627-0095
Mailing Address - Fax:941-629-1872
Practice Address - Street 1:2751 TAMIAMI TRL STE C
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5170
Practice Address - Country:US
Practice Address - Phone:941-627-0095
Practice Address - Fax:941-629-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4206261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center