Provider Demographics
NPI:1487623229
Name:PALM HARBOR CHIROPRACTIC AND REHABILITATION CLINIC, INC.
Entity type:Organization
Organization Name:PALM HARBOR CHIROPRACTIC AND REHABILITATION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-7574
Mailing Address - Street 1:36081 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1531
Mailing Address - Country:US
Mailing Address - Phone:727-786-7574
Mailing Address - Fax:727-773-0863
Practice Address - Street 1:36081 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1531
Practice Address - Country:US
Practice Address - Phone:727-786-7574
Practice Address - Fax:727-773-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7842111NN0400X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53945OtherBLUE CROSS AND BLUE SHIEL
FL381350900Medicaid
FL53945OtherBLUE CROSS AND BLUE SHIEL
FLU82168Medicare UPIN