Provider Demographics
NPI:1710483847
Name:FUNCTIONAL HEATHCARE GROUP PLLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEATHCARE GROUP PLLC
Other - Org Name:FUNCTIONAL HEALTH CARE GROUP PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-813-9299
Mailing Address - Street 1:730 S STERLING AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4542
Mailing Address - Country:US
Mailing Address - Phone:718-813-9299
Mailing Address - Fax:813-658-6215
Practice Address - Street 1:730 S STERLING AVE STE 214
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4542
Practice Address - Country:US
Practice Address - Phone:718-813-9299
Practice Address - Fax:813-658-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12142111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty