Provider Demographics
NPI:1639236748
Name:SOUTH FLORIDA FAMILY CHIROPRACTIC P A
Entity Type:Organization
Organization Name:SOUTH FLORIDA FAMILY CHIROPRACTIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DECANIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-422-1819
Mailing Address - Street 1:1470 ROYAL PALM BEACH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1608
Mailing Address - Country:US
Mailing Address - Phone:561-422-1819
Mailing Address - Fax:561-422-1813
Practice Address - Street 1:1470 ROYAL PALM BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1608
Practice Address - Country:US
Practice Address - Phone:561-422-1819
Practice Address - Fax:561-422-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8849111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7323Medicare ID - Type Unspecified