Provider Demographics
NPI:1659477883
Name:TALLAHASSEE CHIROPRACTIC SPORTS MEDICINE AND REHAB CENTER
Entity Type:Organization
Organization Name:TALLAHASSEE CHIROPRACTIC SPORTS MEDICINE AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-422-2225
Mailing Address - Street 1:230 JOHN KNOX RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-9607
Mailing Address - Country:US
Mailing Address - Phone:850-422-2225
Mailing Address - Fax:850-422-2509
Practice Address - Street 1:230 JOHN KNOX RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-9607
Practice Address - Country:US
Practice Address - Phone:850-422-2225
Practice Address - Fax:850-422-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU33529Medicare UPIN