Provider Demographics
NPI:1912149063
Name:HERITAGE FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HERITAGE FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-927-2161
Mailing Address - Street 1:2206 JO AN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4080
Mailing Address - Country:US
Mailing Address - Phone:941-927-2161
Mailing Address - Fax:941-927-2130
Practice Address - Street 1:2206 JO AN DR STE 1
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4080
Practice Address - Country:US
Practice Address - Phone:941-927-2161
Practice Address - Fax:941-927-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty