Provider Demographics
NPI:1700434974
Name:ANCHOR SPORTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ANCHOR SPORTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABENOJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-887-6466
Mailing Address - Street 1:9824 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1910
Mailing Address - Country:US
Mailing Address - Phone:718-887-6466
Mailing Address - Fax:
Practice Address - Street 1:2655 STATE ROAD 580 STE 204
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3167
Practice Address - Country:US
Practice Address - Phone:727-304-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty