Provider Demographics
NPI:1790931277
Name:RAYMOND D. CLITES D.C., P.A.
Entity Type:Organization
Organization Name:RAYMOND D. CLITES D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CLITES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-684-1648
Mailing Address - Street 1:134 N MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4420
Mailing Address - Country:US
Mailing Address - Phone:813-684-1648
Mailing Address - Fax:813-684-1748
Practice Address - Street 1:134 N MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4420
Practice Address - Country:US
Practice Address - Phone:813-684-1648
Practice Address - Fax:813-684-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380271000Medicaid
FLT-84462Medicare UPIN