NPIMap

Organization Active NPI

East Lake Chiropractic and Injury Center Inc

  • Chiropractor
  • Saint Cloud, FL
National Provider Identifier
1053574855
Registry record updated Apr 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH9561 Issued in FL
Legal business name
EAST LAKE CHIROPRACTIC AND INJURY CENTER INC
Practice address
4028 13TH St
Saint Cloud, FL 34769-6773
Phone
(407) 957-9995
NPI assigned
Jul 2, 2008
Last updated
Apr 26, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Christopher Lee McNichols, D.C.NPI 1760642524
Title
President
Phone
(407) 957-9995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH9561 FL Primary

Addresses

Primary practice location

4028 13TH St
Saint Cloud, FL 34769-6773

Mailing address

4028 13TH St
Saint Cloud, FL 34769-6773
Phone (407) 957-9995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081118000604 FL Part B Supplier - Clinic/Group Practice 4385704501 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Cloud, FL

National Provider Directory

National Provider Directory

Locations

4028 13th St
Saint Cloud, FL 34769
Phone (407) 744-7539

4044 13th St
Saint Cloud, FL 34769
Phone (407) 957-9995

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1053574855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696773",
            "telephone_number": "407-957-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696773",
            "telephone_number": "407-957-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE CHIROPRACTIC AND INJURY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2017-04-26",
        "status": "A",
        "authorized_official_last_name": "MCNICHOLS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-957-9995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.