Provider Demographics
NPI:1760007736
Name:WILLIAM C CHANEY DC PA
Entity Type:Organization
Organization Name:WILLIAM C CHANEY DC PA
Other - Org Name:CHANEY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-686-6385
Mailing Address - Street 1:22 REGINA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4085
Mailing Address - Country:US
Mailing Address - Phone:352-270-8869
Mailing Address - Fax:352-270-8899
Practice Address - Street 1:22 REGINA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-4085
Practice Address - Country:US
Practice Address - Phone:352-270-8869
Practice Address - Fax:352-270-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103453600Medicaid