Provider Demographics
NPI:1568822542
Name:INDIAN ROCKS FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:INDIAN ROCKS FAMILY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-585-8888
Mailing Address - Street 1:13002 SEMINOLE BLVD
Mailing Address - Street 2:#4
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2125
Mailing Address - Country:US
Mailing Address - Phone:727-585-8888
Mailing Address - Fax:
Practice Address - Street 1:13002 SEMINOLE BLVD
Practice Address - Street 2:#4
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2125
Practice Address - Country:US
Practice Address - Phone:727-585-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381074700Medicaid
FL381074700Medicaid
FL55159Medicare PIN