Provider Demographics
NPI:1649740135
Name:CHIROPRACTICUSA OCALA EAST,LLC
Entity type:Organization
Organization Name:CHIROPRACTICUSA OCALA EAST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENNY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:EDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-270-2884
Mailing Address - Street 1:7668 SW 60TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6404
Mailing Address - Country:US
Mailing Address - Phone:352-351-2872
Mailing Address - Fax:352-351-0003
Practice Address - Street 1:942 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3914
Practice Address - Country:US
Practice Address - Phone:352-351-2872
Practice Address - Fax:352-351-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty