Aqui Chiropractic Clinic LLC
Organization Active NPI Chiropractor · Bartow, FL
NPI 1063626844 · NPPES record last updated Feb 6, 2013
Key facts
- NPI
- 1063626844
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH7980 (FL)
- Legal business name
- AQUI CHIROPRACTIC CLINIC LLC
- Practice address
- 1350 E Main St Ste B-4
Bartow, FL 33830-5064 - Phone
- (863) 534-3288
- NPI assigned
- May 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Alexis G Aqui, DC
- Title
- Owner
- Phone
- (863) 534-3288
Practitioners 1
-
Alexis G Aqui, D.C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2069825 | Aqui Chiropractic Clinic LLC | Certificate of waiver | Dec 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070824000566 | FL | Part B Supplier - Clinic/Group Practice | 2466544283 |
Receives reassigned benefits from 1 practitioner Practice locations: Bartow, FL |
National Provider Directory
Locations
1350 E Main St
Ste B-1
Bartow, FL 33830
Phone (863) 534-3288
1350 E Main St
Ste B-4
Bartow, FL 33830
Phone (863) 534-3288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CH7980 | FL | Yes |
Addresses
Primary practice location
1350 E Main St Ste B-4
Bartow, FL 33830-5064
Mailing address
1350 E Main St Ste B-4
Bartow, FL 33830-5064
Phone (863) 534-3288
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 381564100 | Medicaid | FL | |
| 53895 | Other | FL | BC BS OF FL |
Other providers in Bartow, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.