Provider Demographics
NPI:1679768410
Name:ACCURATE CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:ACCURATE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRATIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-684-2707
Mailing Address - Street 1:12082 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-7371
Mailing Address - Country:US
Mailing Address - Phone:352-684-2707
Mailing Address - Fax:352-688-1282
Practice Address - Street 1:12082 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7371
Practice Address - Country:US
Practice Address - Phone:352-684-2707
Practice Address - Fax:352-688-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH006649111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00186484001OtherUHC PROVIDER ID#
FL55251OtherBC PRIVIDER ID#
FL00186484001OtherUHC PROVIDER ID#
FL55251OtherBC PRIVIDER ID#