Provider Demographics
NPI:1811390016
Name:OLDSMAR CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:OLDSMAR CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-855-5986
Mailing Address - Street 1:3906 TAMPA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3100
Mailing Address - Country:US
Mailing Address - Phone:813-855-5986
Mailing Address - Fax:813-855-6378
Practice Address - Street 1:3906 TAMPA RD
Practice Address - Street 2:SUITE A
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3100
Practice Address - Country:US
Practice Address - Phone:813-855-5986
Practice Address - Fax:813-855-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4140261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053598200Medicaid
FL70383Medicare UPIN