Provider Demographics
NPI:1811056518
Name:HORNBACK, CYNTHIA LEE (BS, DC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 GATEWOOD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211
Mailing Address - Country:US
Mailing Address - Phone:941-744-1585
Mailing Address - Fax:941-744-1572
Practice Address - Street 1:11023 GATEWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211
Practice Address - Country:US
Practice Address - Phone:941-744-1585
Practice Address - Fax:941-744-1572
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8217111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70698OtherBLUE CROSS BLUE SHIELD
FL70698OtherBLUE CROSS BLUE SHIELD
FLU90159Medicare UPIN