Provider Demographics
NPI:1801157524
Name:TREASURE COAST FAMILY & SPORTS CHIROPRACTIC, PA
Entity type:Organization
Organization Name:TREASURE COAST FAMILY & SPORTS CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-631-3995
Mailing Address - Street 1:1635 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0435
Mailing Address - Country:US
Mailing Address - Phone:772-631-3995
Mailing Address - Fax:772-905-4015
Practice Address - Street 1:1635 14TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0435
Practice Address - Country:US
Practice Address - Phone:772-631-3995
Practice Address - Fax:772-631-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8776111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID