Provider Demographics
NPI:1184617748
Name:WELSH CLINIC OF CHIROPRACTIC PA
Entity type:Organization
Organization Name:WELSH CLINIC OF CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-962-2489
Mailing Address - Street 1:5121 EHRLICH RD
Mailing Address - Street 2:ST 109
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2049
Mailing Address - Country:US
Mailing Address - Phone:813-962-2489
Mailing Address - Fax:813-962-8781
Practice Address - Street 1:5121 EHRLICH RD
Practice Address - Street 2:ST 109
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2049
Practice Address - Country:US
Practice Address - Phone:813-962-2489
Practice Address - Fax:813-962-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2012-01-03
Deactivation Date:2005-09-02
Deactivation Code:
Reactivation Date:2005-09-21
Provider Licenses
StateLicense IDTaxonomies
IL038004210111N00000X
IN08000863111N00000X
FLCH3746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
88897Medicare ID - Type Unspecified