Provider Demographics
NPI:1174886899
Name:CROSS CHIROPRACTIC CLINIC INCORPORATED
Entity type:Organization
Organization Name:CROSS CHIROPRACTIC CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-875-1747
Mailing Address - Street 1:1102 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2212
Mailing Address - Country:US
Mailing Address - Phone:850-875-1747
Mailing Address - Fax:850-627-3853
Practice Address - Street 1:1102 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2212
Practice Address - Country:US
Practice Address - Phone:850-875-1747
Practice Address - Fax:850-627-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty