Provider Demographics
NPI:1760809636
Name:MARY ESTHER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MARY ESTHER CHIROPRACTIC LLC
Other - Org Name:MARY ESTHER CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:TEGLA
Authorized Official - Last Name:LEITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-243-3993
Mailing Address - Street 1:323 PAGE BACON RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1669
Mailing Address - Country:US
Mailing Address - Phone:850-243-3993
Mailing Address - Fax:850-243-3993
Practice Address - Street 1:323 PAGE BACON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1669
Practice Address - Country:US
Practice Address - Phone:850-243-3993
Practice Address - Fax:850-243-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty