Healthcare Provider Details

I. General information

NPI: 1760728208
Provider Name (Legal Business Name): MADRID CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 BEE RIDGE RD
SARASOTA FL
34239-6108
US

IV. Provider business mailing address

5830 MIDNIGHT PASS RD UNIT 304
SARASOTA FL
34242-2108
US

V. Phone/Fax

Practice location:
  • Phone: 941-954-3700
  • Fax: 941-923-3882
Mailing address:
  • Phone: 941-587-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME 57417
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 8112
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10751
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS Q JACOBS
Title or Position: DIRECTOR
Credential: D.C.
Phone: 941-587-8684