Provider Demographics
NPI:1609067198
Name:WOMACK & WOMACK PA
Entity Type:Organization
Organization Name:WOMACK & WOMACK PA
Other - Org Name:WOMACK CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-723-2113
Mailing Address - Street 1:1430 PALM BAY RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3829
Mailing Address - Country:US
Mailing Address - Phone:321-723-2113
Mailing Address - Fax:321-952-0848
Practice Address - Street 1:1430 PALM BAY RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3829
Practice Address - Country:US
Practice Address - Phone:321-723-2113
Practice Address - Fax:321-952-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005439111N00000X
FLCH0005440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCR270AMedicare PIN