Provider Demographics
NPI:1780007070
Name:ORTEGA CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:ORTEGA CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-425-4545
Mailing Address - Street 1:5367 ORTEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8451
Mailing Address - Country:US
Mailing Address - Phone:904-425-4545
Mailing Address - Fax:904-425-4548
Practice Address - Street 1:5367 ORTEGA BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8451
Practice Address - Country:US
Practice Address - Phone:904-425-4545
Practice Address - Fax:904-425-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381430100Medicaid
FL22384BMedicare PIN
FLU19430Medicare UPIN