Provider Demographics
NPI:1841531969
Name:DR BOB HAWTHORNE CHIROPRACTOR
Entity type:Organization
Organization Name:DR BOB HAWTHORNE CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-383-7262
Mailing Address - Street 1:4001 SWIFT RD
Mailing Address - Street 2:STE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 SWIFT RD
Practice Address - Street 2:STE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6578
Practice Address - Country:US
Practice Address - Phone:941-383-7262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380723100Medicaid
22630AMedicare PIN
FL380723100Medicaid