Provider Demographics
NPI:1952662728
Name:BANDUR CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BANDUR CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BANDUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-394-3477
Mailing Address - Street 1:1766 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2778
Mailing Address - Country:US
Mailing Address - Phone:352-394-3477
Mailing Address - Fax:352-394-2934
Practice Address - Street 1:1766 E HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2778
Practice Address - Country:US
Practice Address - Phone:352-394-3477
Practice Address - Fax:352-394-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55993BMedicare PIN