Provider Demographics
NPI:1922151281
Name:TOTAL HEALTH PHYSICAL MEDICINE PA
Entity Type:Organization
Organization Name:TOTAL HEALTH PHYSICAL MEDICINE PA
Other - Org Name:TOTAL HEALTH OF VERO BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:STEPANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-778-2225
Mailing Address - Street 1:2006 32ND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2430
Mailing Address - Country:US
Mailing Address - Phone:772-778-2225
Mailing Address - Fax:772-778-0304
Practice Address - Street 1:2006 32ND AVE
Practice Address - Street 2:STE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2430
Practice Address - Country:US
Practice Address - Phone:772-778-2225
Practice Address - Fax:772-778-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007426111N00000X
FLCH8907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5961Medicare ID - Type Unspecified