Provider Demographics
NPI:1023432176
Name:FELTS FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:FELTS FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-743-0039
Mailing Address - Street 1:5800 OVERSEAS HWY
Mailing Address - Street 2:SUITE 33
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050
Mailing Address - Country:US
Mailing Address - Phone:305-743-0039
Mailing Address - Fax:
Practice Address - Street 1:5800 OVERSEAS HWY
Practice Address - Street 2:SUITE 33
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2735
Practice Address - Country:US
Practice Address - Phone:305-743-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty