Healthcare Provider Details

I. General information

NPI: 1619906476
Provider Name (Legal Business Name): KUCHARIK CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13035 PARK BLVD
SEMINOLE FL
33776-3641
US

IV. Provider business mailing address

13035 PARK BLVD
SEMINOLE FL
33776-3641
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-8700
  • Fax: 727-393-8770
Mailing address:
  • Phone: 727-393-8700
  • Fax: 727-393-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0003558
License Number StateFL

VIII. Authorized Official

Name: DR. EDWARD J KUCHARIK
Title or Position: PRESIDENT
Credential: DC
Phone: 727-393-8700