Provider Demographics
NPI:1922370246
Name:PREMIER HEALTH ORMOND, INC
Entity Type:Organization
Organization Name:PREMIER HEALTH ORMOND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC SERVICES DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-872-3600
Mailing Address - Street 1:325 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE #390
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8178
Mailing Address - Country:US
Mailing Address - Phone:386-872-3600
Mailing Address - Fax:386-615-9137
Practice Address - Street 1:325 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE #390
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8178
Practice Address - Country:US
Practice Address - Phone:386-872-3600
Practice Address - Fax:386-615-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10080111N00000X
FL057503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty