Provider Demographics
NPI:1619906476
Name:KUCHARIK CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:KUCHARIK CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUCHARIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-393-8700
Mailing Address - Street 1:13035 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3641
Mailing Address - Country:US
Mailing Address - Phone:727-393-8700
Mailing Address - Fax:727-393-8770
Practice Address - Street 1:13035 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3641
Practice Address - Country:US
Practice Address - Phone:727-393-8700
Practice Address - Fax:727-393-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050575700Medicaid
FL70720OtherBLUE CROSS BLUE SHIELD
FL70720OtherBLUE CROSS BLUE SHIELD
FLU20410Medicare UPIN