Provider Demographics
NPI:1891332201
Name:CHRISTIE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CHRISTIE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-339-8876
Mailing Address - Street 1:PO BOX 360864
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0864
Mailing Address - Country:US
Mailing Address - Phone:321-339-8876
Mailing Address - Fax:321-541-9114
Practice Address - Street 1:1501 AVOCADO AVE STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6593
Practice Address - Country:US
Practice Address - Phone:321-339-8876
Practice Address - Fax:321-541-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty