Provider Demographics
NPI:1770752081
Name:CHIROPRACTICUSA OF JASMINE INC
Entity type:Organization
Organization Name:CHIROPRACTICUSA OF JASMINE INC
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:M
Authorized Official - Last Name:EDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-270-2884
Mailing Address - Street 1:7668 S.W. 60TH AVENUE
Mailing Address - Street 2:SUITE 500
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 1:7668 S.W. 60TH AVENUE
Practice Address - Street 2:SUITE 500
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6404
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:2008-02-21
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000374500Medicaid
FL40095OtherBCBS
FLA1977Medicare PIN