Healthcare Provider Details

I. General information

NPI: 1619963147
Provider Name (Legal Business Name): FOUR CORNERS CHIROPRACTIC CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 US HIGHWAY 27 SUITE 7
CLERMONT FL
34714-7508
US

IV. Provider business mailing address

PO BOX 135818
CLERMONT FL
34713-5818
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-7771
  • Fax: 352-394-7784
Mailing address:
  • Phone: 352-394-7771
  • Fax: 352-394-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8554
License Number StateFL

VIII. Authorized Official

Name: SCOTT DAVID BARNHART
Title or Position: PRESIDENT/OWNER/CHIROPRACTOR
Credential: DC
Phone: 352-394-7771