Provider Demographics
NPI:1942392824
Name:MARION CHIROPRACTIC ASSOCIATES P A
Entity Type:Organization
Organization Name:MARION CHIROPRACTIC ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VAZOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:353-817-3783
Mailing Address - Street 1:7133 SE MARICAMP RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-2103
Mailing Address - Country:US
Mailing Address - Phone:352-680-0031
Mailing Address - Fax:352-680-1288
Practice Address - Street 1:7133 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2103
Practice Address - Country:US
Practice Address - Phone:352-680-0031
Practice Address - Fax:352-680-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU93179Medicare UPIN
FLAC472Medicare PIN