Provider Demographics
NPI:1134145881
Name:HOMESTEAD CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:HOMESTEAD CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-247-2804
Mailing Address - Street 1:125 NE 8TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:305-247-2804
Mailing Address - Fax:305-247-9471
Practice Address - Street 1:125 NE 8TH ST
Practice Address - Street 2:STE 3
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-247-2804
Practice Address - Fax:305-247-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05294Medicare UPIN
FL22855Medicare ID - Type Unspecified