Provider Demographics
NPI:1255515029
Name:ST GERMAIN CHIROPRACTIC,PA
Entity type:Organization
Organization Name:ST GERMAIN CHIROPRACTIC,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-889-3223
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1657
Mailing Address - Country:US
Mailing Address - Phone:407-889-3223
Mailing Address - Fax:407-889-7263
Practice Address - Street 1:877 S ORANGE BLOSSOM TRAIL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6522
Practice Address - Country:US
Practice Address - Phone:407-889-3223
Practice Address - Fax:407-889-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL434ZMedicare PIN
FL38118Medicare PIN
FLBP639ZMedicare PIN
FLBP584ZMedicare PIN
FLDE264ZMedicare PIN
FLBP600ZMedicare PIN