Provider Demographics
NPI:1629194097
Name:BARDMOOR CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:BARDMOOR CHIROPRACTIC CENTER, INC.
Other - Org Name:FLORIDA HEALTH AND WELLNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:MADOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-548-8100
Mailing Address - Street 1:7500 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1437
Mailing Address - Country:US
Mailing Address - Phone:727-548-8100
Mailing Address - Fax:727-548-8112
Practice Address - Street 1:7500 BRYAN DAIRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1437
Practice Address - Country:US
Practice Address - Phone:727-548-8100
Practice Address - Fax:727-548-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22693OtherBCBS
FL44-88108OtherUHC
FL22693Medicare ID - Type Unspecified
FL22693OtherBCBS