Provider Demographics
NPI:1336202514
Name:CHIROPRACTIC ASSOCIATES OF GAINESVILLE INC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF GAINESVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RICHESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-372-4110
Mailing Address - Street 1:3703 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-372-4110
Mailing Address - Fax:352-373-0111
Practice Address - Street 1:3703 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-372-4110
Practice Address - Fax:352-373-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45925Medicare PIN