Provider Demographics
NPI:1811173230
Name:CHARLES E LIOTT D C P A
Entity type:Organization
Organization Name:CHARLES E LIOTT D C P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-923-2567
Mailing Address - Street 1:2477 STICKNEY POINT RD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4076
Mailing Address - Country:US
Mailing Address - Phone:941-923-2567
Mailing Address - Fax:
Practice Address - Street 1:2477 STICKNEY POINT RD
Practice Address - Street 2:SUITE 202A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4076
Practice Address - Country:US
Practice Address - Phone:941-923-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45906OtherBLUE CROSS GROUP
FLCB4770Medicare PIN
FL45906OtherBLUE CROSS GROUP