Provider Demographics
NPI:1255526109
Name:SOROKA STARBUCK PA DBA FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:SOROKA STARBUCK PA DBA FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SOROKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-231-2011
Mailing Address - Street 1:35 CLAYTON LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5781
Mailing Address - Country:US
Mailing Address - Phone:850-231-0211
Mailing Address - Fax:850-231-6006
Practice Address - Street 1:35 CLAYTON LN
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5781
Practice Address - Country:US
Practice Address - Phone:850-231-0211
Practice Address - Fax:850-231-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380668500Medicaid
FLT94473Medicare UPIN