Provider Demographics
NPI:1689922346
Name:CAPE CORAL FAMILY CHIROPRACTIC CENTER, PL
Entity Type:Organization
Organization Name:CAPE CORAL FAMILY CHIROPRACTIC CENTER, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-574-8000
Mailing Address - Street 1:210 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1763
Mailing Address - Country:US
Mailing Address - Phone:239-574-8000
Mailing Address - Fax:239-574-1004
Practice Address - Street 1:210 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 3
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1763
Practice Address - Country:US
Practice Address - Phone:239-574-8000
Practice Address - Fax:239-574-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22840Medicare PIN
FMU38949Medicare UPIN