Provider Demographics
NPI:1831370568
Name:DOWNTOWN CHIROPRACTIC AND SPORTS DEVELOPMENT CENTER PA
Entity type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC AND SPORTS DEVELOPMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:850-570-0208
Mailing Address - Street 1:PO BOX 14593
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4593
Mailing Address - Country:US
Mailing Address - Phone:850-570-0208
Mailing Address - Fax:
Practice Address - Street 1:2056 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-878-2363
Practice Address - Fax:850-878-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty