Provider Demographics
NPI:1801919444
Name:CHERY, CARINE (DC)
Entity type:Individual
Prefix:
First Name:CARINE
Middle Name:
Last Name:CHERY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CRYSTAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7707
Mailing Address - Country:US
Mailing Address - Phone:239-936-6566
Mailing Address - Fax:239-936-6442
Practice Address - Street 1:1900 CRYSTAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7707
Practice Address - Country:US
Practice Address - Phone:239-936-6566
Practice Address - Fax:239-936-6442
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55782OtherBLUE CROSS & BLUE SHIELD
FL382055600Medicaid
FL55782OtherBLUE CROSS & BLUE SHIELD