Provider Demographics
NPI:1982997896
Name:HEART OF FLORIDA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HEART OF FLORIDA CHIROPRACTIC, INC.
Other - Org Name:HEART OF FLORIDA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:863-422-4575
Mailing Address - Street 1:350 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5602
Mailing Address - Country:US
Mailing Address - Phone:863-422-4575
Mailing Address - Fax:863-422-4573
Practice Address - Street 1:350 S 10TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5602
Practice Address - Country:US
Practice Address - Phone:863-422-4575
Practice Address - Fax:863-422-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty