Provider Demographics
NPI:1255532156
Name:TOTALLY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:TOTALLY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-265-8200
Mailing Address - Street 1:108 MYRTLE RIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5645
Mailing Address - Country:US
Mailing Address - Phone:813-265-8200
Mailing Address - Fax:813-406-4438
Practice Address - Street 1:108 MYRTLE RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5645
Practice Address - Country:US
Practice Address - Phone:813-265-8200
Practice Address - Fax:813-406-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty