Provider Demographics
NPI:1679994602
Name:COMPLETE CHIROPRACTIC CARE, PA
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC CARE, PA
Other - Org Name:CHIROBLISS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-505-5654
Mailing Address - Street 1:1850 LEE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2106
Mailing Address - Country:US
Mailing Address - Phone:407-505-5654
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 207
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2106
Practice Address - Country:US
Practice Address - Phone:407-505-5654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992839153OtherINDIVIDUAL NPI