Provider Demographics
NPI:1801919378
Name:CERWINSKY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:CERWINSKY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CERWINSKY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:239-936-5545
Mailing Address - Street 1:1560 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1702
Mailing Address - Country:US
Mailing Address - Phone:239-936-5545
Mailing Address - Fax:239-936-5482
Practice Address - Street 1:1560 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1702
Practice Address - Country:US
Practice Address - Phone:239-936-5545
Practice Address - Fax:239-936-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381138700Medicaid
55725Medicare ID - Type Unspecified
FL381138700Medicaid