Provider Demographics
NPI:1396956066
Name:PATON CHIROPRACTIC AND SPORTS MEDICINE, INC
Entity type:Organization
Organization Name:PATON CHIROPRACTIC AND SPORTS MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, ATC
Authorized Official - Phone:813-949-7740
Mailing Address - Street 1:24722 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6226
Mailing Address - Country:US
Mailing Address - Phone:813-949-7740
Mailing Address - Fax:
Practice Address - Street 1:24722 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6226
Practice Address - Country:US
Practice Address - Phone:813-949-7740
Practice Address - Fax:813-949-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381767900Medicaid
FLK5390Medicare ID - Type Unspecified
FL381767900Medicaid