Provider Demographics
NPI:1881834794
Name:BIG IDEA CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:BIG IDEA CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-226-4440
Mailing Address - Street 1:151 MARY ESTHER BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1975
Mailing Address - Country:US
Mailing Address - Phone:850-226-4440
Mailing Address - Fax:
Practice Address - Street 1:151 MARY ESTHER BLVD STE 408
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1975
Practice Address - Country:US
Practice Address - Phone:850-226-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center