Provider Demographics
NPI:1821149121
Name:CECIL E. ASHBY III, D.C., P.A.
Entity Type:Organization
Organization Name:CECIL E. ASHBY III, D.C., P.A.
Other - Org Name:ATLANTIC WELLNESS CENTER OF FLAGLER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:386-439-0005
Mailing Address - Street 1:212 MOODY BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3372
Mailing Address - Country:US
Mailing Address - Phone:386-439-0005
Mailing Address - Fax:386-439-0002
Practice Address - Street 1:212 MOODY BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3372
Practice Address - Country:US
Practice Address - Phone:386-439-0005
Practice Address - Fax:386-439-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64941Medicare UPIN
0005390Medicare ID - Type Unspecified