Provider Demographics
NPI:1922350826
Name:WORTHINGTON CHIROPRACTIC
Entity Type:Organization
Organization Name:WORTHINGTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-377-3050
Mailing Address - Street 1:5618 NW 43RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3407
Mailing Address - Country:US
Mailing Address - Phone:352-377-3050
Mailing Address - Fax:
Practice Address - Street 1:5618 NW 43RD ST STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3407
Practice Address - Country:US
Practice Address - Phone:352-377-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty