Provider Demographics
NPI:1700288040
Name:CELEBRATION FAMILY CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:CELEBRATION FAMILY CHIROPRACTIC CLINIC INC
Other - Org Name:CELEBRATION FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TWEETEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-939-2328
Mailing Address - Street 1:604 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4675
Mailing Address - Country:US
Mailing Address - Phone:321-939-2328
Mailing Address - Fax:407-965-4485
Practice Address - Street 1:604 FRONT ST
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4675
Practice Address - Country:US
Practice Address - Phone:321-939-2328
Practice Address - Fax:407-965-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770619587Medicare UPIN