Provider Demographics
NPI:1639387442
Name:SROUR CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SROUR CHIROPRACTIC INC
Other - Org Name:PRO HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SROUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-891-2520
Mailing Address - Street 1:1948 NE 123RD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2800
Mailing Address - Country:US
Mailing Address - Phone:305-891-2520
Mailing Address - Fax:305-891-5754
Practice Address - Street 1:1948 NE 123RD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2800
Practice Address - Country:US
Practice Address - Phone:305-891-2520
Practice Address - Fax:305-891-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH529Medicare PIN