Provider Demographics
NPI:1912511684
Name:KEVIN USRY DC LLC
Entity Type:Organization
Organization Name:KEVIN USRY DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:USRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-863-8779
Mailing Address - Street 1:1541 PROSPERITY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2025
Mailing Address - Country:US
Mailing Address - Phone:561-863-8779
Mailing Address - Fax:
Practice Address - Street 1:1541 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2025
Practice Address - Country:US
Practice Address - Phone:561-863-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL5055OtherLICENSE NUMBER