Provider Demographics
NPI:1598754095
Name:DORAN R DORAZIO DC PA
Entity Type:Organization
Organization Name:DORAN R DORAZIO DC PA
Other - Org Name:A BACK & NECK PAIN RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DORAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-935-2099
Mailing Address - Street 1:3333 W WATERS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2758
Mailing Address - Country:US
Mailing Address - Phone:813-935-2099
Mailing Address - Fax:813-935-1388
Practice Address - Street 1:3333 W WATERS AVE
Practice Address - Street 2:STE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2758
Practice Address - Country:US
Practice Address - Phone:813-935-2099
Practice Address - Fax:813-935-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T95241Medicare UPIN
FL88825Medicare PIN