Provider Demographics
NPI:1669406872
Name:SOTO CHIROPRACTIC & PHYSICAL THERAPY CENTERS
Entity type:Organization
Organization Name:SOTO CHIROPRACTIC & PHYSICAL THERAPY CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:561-758-6634
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-0727
Mailing Address - Country:US
Mailing Address - Phone:561-996-4242
Mailing Address - Fax:561-996-4232
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4910
Practice Address - Country:US
Practice Address - Phone:561-996-4242
Practice Address - Fax:561-996-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381829200Medicaid
FLU3535YMedicare PIN
FL381829200Medicaid