Provider Demographics
NPI:1265750863
Name:PROSCIA CHIROPRACTIC ASSOCIATES LP
Entity type:Organization
Organization Name:PROSCIA CHIROPRACTIC ASSOCIATES LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:HUDOCK
Authorized Official - Last Name:PROSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-788-2855
Mailing Address - Street 1:701 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1823
Mailing Address - Country:US
Mailing Address - Phone:386-788-2855
Mailing Address - Fax:386-788-2869
Practice Address - Street 1:701 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1823
Practice Address - Country:US
Practice Address - Phone:386-788-2855
Practice Address - Fax:386-788-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty