Provider Demographics
NPI:1932144631
Name:CHIROPRACTIC IN THE PARK, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC IN THE PARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LAURANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-547-8615
Mailing Address - Street 1:8695 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4527
Mailing Address - Country:US
Mailing Address - Phone:727-547-8615
Mailing Address - Fax:727-547-0918
Practice Address - Street 1:8695 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4527
Practice Address - Country:US
Practice Address - Phone:727-547-8615
Practice Address - Fax:727-547-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7061111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381162000Medicaid
FL381162000Medicaid
U65568Medicare UPIN