Provider Demographics
NPI:1568640803
Name:BAYSHORE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BAYSHORE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ELLLIOT
Authorized Official - Last Name:DRALUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-417-0010
Mailing Address - Street 1:4000 BAYSHORE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6503
Mailing Address - Country:US
Mailing Address - Phone:239-417-0010
Mailing Address - Fax:239-417-0010
Practice Address - Street 1:4000 BAYSHORE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6503
Practice Address - Country:US
Practice Address - Phone:239-417-0010
Practice Address - Fax:239-417-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center