Provider Demographics
NPI:1801084330
Name:JOHN S CHOMER DC MD PC
Entity type:Organization
Organization Name:JOHN S CHOMER DC MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC MD PC
Authorized Official - Phone:850-863-4700
Mailing Address - Street 1:625 LOVEJOY RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-3838
Mailing Address - Country:US
Mailing Address - Phone:850-863-4700
Mailing Address - Fax:850-863-4763
Practice Address - Street 1:625 LOVEJOY RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-3838
Practice Address - Country:US
Practice Address - Phone:850-863-4700
Practice Address - Fax:850-863-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85933111N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8081Medicare PIN