Provider Demographics
NPI:1548492317
Name:AVE MARIA CHIROPRACTIC
Entity type:Organization
Organization Name:AVE MARIA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-348-1696
Mailing Address - Street 1:5080 ANNUNCIATION CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5080 ANNUNCIATION CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9648
Practice Address - Country:US
Practice Address - Phone:239-348-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9623261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center