Provider Demographics
NPI:1952584625
Name:COMPREHENSIVE PHYSICIANS GROUP PA
Entity Type:Organization
Organization Name:COMPREHENSIVE PHYSICIANS GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-332-1904
Mailing Address - Street 1:499 E CENTRAL PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-332-1904
Mailing Address - Fax:407-332-1206
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-332-1904
Practice Address - Fax:407-332-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22098ZOtherBCBS
22098ZOtherBCBS