Provider Demographics
NPI:1770028474
Name:S & B CHIROPRACTIC AND REHAB, INC.
Entity Type:Organization
Organization Name:S & B CHIROPRACTIC AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRITTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-272-0501
Mailing Address - Street 1:PO BOX 48558
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0122
Mailing Address - Country:US
Mailing Address - Phone:813-359-9049
Mailing Address - Fax:
Practice Address - Street 1:14523 BRUCE B DOWNS BLVD
Practice Address - Street 2:STE 405
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6501
Practice Address - Country:US
Practice Address - Phone:813-359-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10085302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200843480Medicaid
IN200843480Medicaid