Provider Demographics
NPI:1780918730
Name:FT. MYERS CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:FT. MYERS CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-362-1338
Mailing Address - Street 1:8140 COLLEGE PKWY
Mailing Address - Street 2:107
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5188
Mailing Address - Country:US
Mailing Address - Phone:239-362-1338
Mailing Address - Fax:239-362-1339
Practice Address - Street 1:8140 COLLEGE PKWY
Practice Address - Street 2:107
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5188
Practice Address - Country:US
Practice Address - Phone:239-362-1338
Practice Address - Fax:239-362-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty