Provider Demographics
NPI:1831233188
Name:PRICE, SEAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:LEE
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745C BEAL PKWY NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3093
Mailing Address - Country:US
Mailing Address - Phone:850-862-2224
Mailing Address - Fax:850-862-2204
Practice Address - Street 1:745C BEAL PKWY NW
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3093
Practice Address - Country:US
Practice Address - Phone:850-862-2224
Practice Address - Fax:850-862-2204
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89671OtherBLUE CROSS BLUE SHIELD
FL89671ZMedicare ID - Type UnspecifiedMEDICARE
FLCH8813Medicare UPIN
FLK6817Medicare PIN