Provider Demographics
NPI:1730310517
Name:COREHEALTH OF CLEARWATER LLC
Entity Type:Organization
Organization Name:COREHEALTH OF CLEARWATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-216-3216
Mailing Address - Street 1:1501 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2236
Mailing Address - Country:US
Mailing Address - Phone:727-216-3216
Mailing Address - Fax:727-216-3177
Practice Address - Street 1:1501 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2236
Practice Address - Country:US
Practice Address - Phone:727-216-3216
Practice Address - Fax:727-216-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty