Provider Demographics
NPI:1619180908
Name:CHIROPRACTIC PLACE LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC PLACE LLC
Other - Org Name:KAIZEN WELLNESS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-887-3066
Mailing Address - Street 1:7051 CYPRESS TER
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8822
Mailing Address - Country:US
Mailing Address - Phone:239-887-3066
Mailing Address - Fax:239-887-3074
Practice Address - Street 1:7051 CYPRESS TER
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8822
Practice Address - Country:US
Practice Address - Phone:239-887-3066
Practice Address - Fax:239-887-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH395Medicare PIN