Provider Demographics
NPI:1710170675
Name:HORNBACK CHIROPRACTIC AND WELLNESS PA
Entity Type:Organization
Organization Name:HORNBACK CHIROPRACTIC AND WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HORNBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-744-1585
Mailing Address - Street 1:11023 GATEWOOD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4945
Mailing Address - Country:US
Mailing Address - Phone:941-744-1585
Mailing Address - Fax:941-744-1572
Practice Address - Street 1:11023 GATEWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211
Practice Address - Country:US
Practice Address - Phone:941-744-1585
Practice Address - Fax:941-744-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty