Provider Demographics
NPI:1619087947
Name:SUNCOAST CHIROPRACTIC WELLNESS CENTERS PA
Entity Type:Organization
Organization Name:SUNCOAST CHIROPRACTIC WELLNESS CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ELISEO
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-791-9355
Mailing Address - Street 1:407 N BELCHER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2608
Mailing Address - Country:US
Mailing Address - Phone:727-791-9355
Mailing Address - Fax:727-724-9190
Practice Address - Street 1:407 N BELCHER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2608
Practice Address - Country:US
Practice Address - Phone:727-791-9355
Practice Address - Fax:727-724-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64166OtherBCBS
FLV08095Medicare UPIN
FLU6766ZMedicare ID - Type Unspecified