Provider Demographics
NPI:1710173398
Name:ROBERT A DEMETREE DC INC
Entity Type:Organization
Organization Name:ROBERT A DEMETREE DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMETREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-862-7272
Mailing Address - Street 1:797 N SR 434
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7233
Mailing Address - Country:US
Mailing Address - Phone:407-862-7272
Mailing Address - Fax:407-862-6444
Practice Address - Street 1:797 N SR 434
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7233
Practice Address - Country:US
Practice Address - Phone:407-862-7272
Practice Address - Fax:407-862-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381983300Medicaid
FLK7051Medicare PIN