Provider Demographics
NPI:1265618672
Name:HETHER ACCIDENT & INJURY CENTER
Entity type:Organization
Organization Name:HETHER ACCIDENT & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-761-4001
Mailing Address - Street 1:3959 S NOVA RD
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3959 S NOVA RD
Practice Address - Street 2:SUITE 9B
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9278
Practice Address - Country:US
Practice Address - Phone:386-761-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8703ZMedicare UPIN