Provider Demographics
NPI:1932386067
Name:DR.CARINE CHERY PA
Entity Type:Organization
Organization Name:DR.CARINE CHERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-936-6566
Mailing Address - Street 1:1900 CRYSTAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4105
Mailing Address - Country:US
Mailing Address - Phone:239-936-6566
Mailing Address - Fax:239-936-6442
Practice Address - Street 1:1900 CRYSTAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7707
Practice Address - Country:US
Practice Address - Phone:239-936-6566
Practice Address - Fax:239-936-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55782OtherBLUE CROSS & BLUE SHIELD
FL382055600Medicaid
FL55782OtherBLUE CROSS & BLUE SHIELD