Provider Demographics
NPI:1184388803
Name:DEATRICK FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:DEATRICK FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DEATRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:772-283-6387
Mailing Address - Street 1:6410 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8313
Mailing Address - Country:US
Mailing Address - Phone:772-283-6387
Mailing Address - Fax:772-283-4360
Practice Address - Street 1:6410 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8313
Practice Address - Country:US
Practice Address - Phone:772-283-6387
Practice Address - Fax:772-283-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service