Provider Demographics
NPI:1962671552
Name:AUBURNDALE CHIROPRACTIC,LLC
Entity Type:Organization
Organization Name:AUBURNDALE CHIROPRACTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:BERYL
Authorized Official - Last Name:SUNDERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-968-0088
Mailing Address - Street 1:214 MAIN ST.
Mailing Address - Street 2:AUBURNDALE CHIROPRACTIC, LLC
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823
Mailing Address - Country:US
Mailing Address - Phone:863-968-0088
Mailing Address - Fax:863-968-0181
Practice Address - Street 1:214 MAIN ST.
Practice Address - Street 2:AUBURNDALE CHIROPRACTIC, LLC
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823
Practice Address - Country:US
Practice Address - Phone:863-968-0088
Practice Address - Fax:863-968-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9318Medicare PIN