Provider Demographics
NPI:1659560928
Name:CHIEFLAND CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CHIEFLAND CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-949-0843
Mailing Address - Street 1:410 N. MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626
Mailing Address - Country:US
Mailing Address - Phone:352-949-0843
Mailing Address - Fax:352-490-7177
Practice Address - Street 1:410 N. MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626
Practice Address - Country:US
Practice Address - Phone:352-490-7077
Practice Address - Fax:352-490-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK116Medicare PIN
FLT56411Medicare UPIN