Provider Demographics
NPI:1982373387
Name:FLORIDA CHIROPRACTIC AND REHAB LLC
Entity Type:Organization
Organization Name:FLORIDA CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-309-9550
Mailing Address - Street 1:4424 N LOIS AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7320
Mailing Address - Country:US
Mailing Address - Phone:330-309-9550
Mailing Address - Fax:
Practice Address - Street 1:4424 N LOIS AVE STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7320
Practice Address - Country:US
Practice Address - Phone:330-309-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty