Provider Demographics
NPI:1558734467
Name:PARADISE PALMS CHIROPRACTIC AND SPA, LLC
Entity Type:Organization
Organization Name:PARADISE PALMS CHIROPRACTIC AND SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-948-1781
Mailing Address - Street 1:19011 N DALE MABRY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-9200
Mailing Address - Country:US
Mailing Address - Phone:813-948-1781
Mailing Address - Fax:813-406-4434
Practice Address - Street 1:19011 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-9200
Practice Address - Country:US
Practice Address - Phone:813-948-1781
Practice Address - Fax:813-406-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10645302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization