Provider Demographics
NPI:1952550089
Name:CHIROPRACTIC AND APPLIED KINESIOLOGY CLINIC, INC.
Entity type:Organization
Organization Name:CHIROPRACTIC AND APPLIED KINESIOLOGY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-894-0789
Mailing Address - Street 1:2211 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3105
Mailing Address - Country:US
Mailing Address - Phone:727-894-0789
Mailing Address - Fax:727-821-3143
Practice Address - Street 1:2211 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3105
Practice Address - Country:US
Practice Address - Phone:727-894-0789
Practice Address - Fax:727-821-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70980OtherBCBS