Provider Demographics
NPI:1689791683
Name:MUNDAY CHIROPRACTIC CLINIC P A
Entity Type:Organization
Organization Name:MUNDAY CHIROPRACTIC CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-853-3000
Mailing Address - Street 1:6645 N SOCRUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4182
Mailing Address - Country:US
Mailing Address - Phone:863-853-3000
Mailing Address - Fax:863-859-7640
Practice Address - Street 1:6645 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4182
Practice Address - Country:US
Practice Address - Phone:863-853-3000
Practice Address - Fax:863-859-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty