Provider Demographics
NPI:1689830903
Name:TIMOTHY J. O'GRADY CHIROPRACTIC
Entity Type:Organization
Organization Name:TIMOTHY J. O'GRADY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-468-1000
Mailing Address - Street 1:2708 SOUTH U.S. ONE
Mailing Address - Street 2:
Mailing Address - City:FT. PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-468-1000
Mailing Address - Fax:772-468-1025
Practice Address - Street 1:2708 SOUTH U.S. ONE
Practice Address - Street 2:
Practice Address - City:FT. PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982
Practice Address - Country:US
Practice Address - Phone:772-468-1000
Practice Address - Fax:772-468-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH005451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty