Provider Demographics
NPI:1609144260
Name:NORTHDALE'S FAMILY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:NORTHDALE'S FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:HORCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-960-8447
Mailing Address - Street 1:14855 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2027
Mailing Address - Country:US
Mailing Address - Phone:813-960-8447
Mailing Address - Fax:813-960-8416
Practice Address - Street 1:14855 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2027
Practice Address - Country:US
Practice Address - Phone:813-960-8447
Practice Address - Fax:813-960-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22837Medicare UPIN