Provider Demographics
NPI:1952670440
Name:CHIROPRACTIC & PHYSICAL THERAPY OF FLORIDA, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC & PHYSICAL THERAPY OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-644-7017
Mailing Address - Street 1:2901 W SAINT ISABEL ST STE A2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6350
Mailing Address - Country:US
Mailing Address - Phone:813-644-7017
Mailing Address - Fax:813-644-7018
Practice Address - Street 1:2901 W SAINT ISABEL ST STE A2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-644-7017
Practice Address - Fax:813-644-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty