Provider Demographics
NPI:1245342674
Name:ESENBERG CHIROPRACTIC CENTRE PA
Entity type:Organization
Organization Name:ESENBERG CHIROPRACTIC CENTRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-948-4440
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-0979
Mailing Address - Country:US
Mailing Address - Phone:813-948-4440
Mailing Address - Fax:
Practice Address - Street 1:24426 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7303
Practice Address - Country:US
Practice Address - Phone:813-948-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0336Medicare ID - Type Unspecified