Provider Demographics
NPI:1891005369
Name:FIRST CHOICE CHIROPRACTIC OF ORMOND, INC
Entity Type:Organization
Organization Name:FIRST CHOICE CHIROPRACTIC OF ORMOND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-310-7246
Mailing Address - Street 1:800 STERTHAUS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5132
Mailing Address - Country:US
Mailing Address - Phone:386-310-7246
Mailing Address - Fax:386-310-4952
Practice Address - Street 1:800 STERTHAUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5132
Practice Address - Country:US
Practice Address - Phone:386-310-7246
Practice Address - Fax:386-310-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8484111N00000X
FLCH10046111N00000X
FLCH10229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001E5OtherBCBSFL
FL001E5OtherBCBSFL