Provider Demographics
NPI:1205337821
Name:CHIROS ON 54 LLC
Entity type:Organization
Organization Name:CHIROS ON 54 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLCECORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-428-5648
Mailing Address - Street 1:21754 STATE ROAD 54 STE 101
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6901
Mailing Address - Country:US
Mailing Address - Phone:813-428-5648
Mailing Address - Fax:813-501-8700
Practice Address - Street 1:21754 STATE ROAD 54 STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6901
Practice Address - Country:US
Practice Address - Phone:813-428-5648
Practice Address - Fax:813-501-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty