Provider Demographics
NPI:1295066710
Name:OCALA NATURAL MEDICINE, P.A.
Entity type:Organization
Organization Name:OCALA NATURAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PODLASKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC DABCI,DACBN,CNS
Authorized Official - Phone:352-414-9998
Mailing Address - Street 1:2721 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0710
Mailing Address - Country:US
Mailing Address - Phone:352-414-9998
Mailing Address - Fax:352-867-1015
Practice Address - Street 1:2721 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0710
Practice Address - Country:US
Practice Address - Phone:352-414-9998
Practice Address - Fax:352-867-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4801111NN1001X
FLCH 4801111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55690OtherBC/BS