Provider Demographics
NPI:1205513322
Name:MYCHIRO, LLC
Entity type:Organization
Organization Name:MYCHIRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-515-6000
Mailing Address - Street 1:491 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5680
Mailing Address - Country:US
Mailing Address - Phone:352-515-6000
Mailing Address - Fax:352-610-4387
Practice Address - Street 1:8763 RIVER CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1112
Practice Address - Country:US
Practice Address - Phone:135-251-5600
Practice Address - Fax:352-610-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty