Provider Demographics
NPI:1689706061
Name:LICARI FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LICARI FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LICARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-989-2040
Mailing Address - Street 1:5208 E FOWLER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1906
Mailing Address - Country:US
Mailing Address - Phone:813-989-2040
Mailing Address - Fax:813-989-2049
Practice Address - Street 1:5208 E FOWLER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1906
Practice Address - Country:US
Practice Address - Phone:813-989-2040
Practice Address - Fax:813-989-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50112OtherBLUE CROSSBLUE SHIELD
FL50112OtherBLUE CROSSBLUE SHIELD