Provider Demographics
NPI:1750662524
Name:GAINESVILLE CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GAINESVILLE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-264-0314
Mailing Address - Street 1:5200 NW 43RD ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4484
Mailing Address - Country:US
Mailing Address - Phone:352-264-0314
Mailing Address - Fax:352-264-0315
Practice Address - Street 1:5200 NW 43RD ST
Practice Address - Street 2:SUITE 507
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4484
Practice Address - Country:US
Practice Address - Phone:352-264-0314
Practice Address - Fax:352-264-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty