Provider Demographics
NPI:1801644323
Name:CHIROS WINTER HAVEN LLC
Entity type:Organization
Organization Name:CHIROS WINTER HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLCECORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-428-5648
Mailing Address - Street 1:21754 STATE ROAD 54 STE 101
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6901
Mailing Address - Country:US
Mailing Address - Phone:813-428-5648
Mailing Address - Fax:813-501-8700
Practice Address - Street 1:301 3RD ST NW STE 204
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4094
Practice Address - Country:US
Practice Address - Phone:863-268-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROS ON 54 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty