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General NPI Number Information
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NPI Number | 1548580566
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Entity Type | Organization
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Legal Business Name | VANDERBECK CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 2751 TAMIAMI TRL STE C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5170
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Country | US
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Telephone | 941-627-0095
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Fax | 941-629-1872
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Provider Business Mailing Address
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Address Line | 2751 TAMIAMI TRL STE C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5170
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Country | US
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Telephone | 941-627-0095
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Fax | 941-629-1872
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES VANDERBECK
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Credential | D.C.
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Telephone | 941-627-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH4206
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License Number State | FL
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