Debary Chiropractic Center Corp
Organization Active NPI Chiropractor · Debary, FL
NPI 1255853461 · NPPES record last updated Jan 20, 2021
Key facts
- NPI
- 1255853461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH12148 (FL)
- Legal business name
- DEBARY CHIROPRACTIC CENTER CORP
- Practice address
- 70 Fox Ridge CT Ste a
Debary, FL 32713-2752 - Phone
- (386) 668-6321
- NPI assigned
- Jul 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Jamie Grainger, DC
- Title
- Owner
- Phone
- (386) 668-6321
Subparts reporting this organization as parent 1
Member organizations 1
Practitioners 3
-
Jamie Grainger, D.C.
-
Dianne Marie Harbers, LMT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171006001874 | FL | Part B Supplier - Clinic/Group Practice | 6103191770 |
Receives reassigned benefits from 1 practitioner Practice locations: Debary, FL |
National Provider Directory
Locations
58 N US Highway 17 92
Ste B
Debary, FL 32713
Phone (386) 668-6321
70 Fox Ridge Ct
Ste A
Debary, FL 32713
Phone (386) 668-4411
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CH12148 | FL | Yes |
Addresses
Primary practice location
70 Fox Ridge CT Ste a
Debary, FL 32713-2752
Mailing address
70 Fox Ridge CT Ste a
Debary, FL 32713-2752
Phone (386) 668-6321
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 058586 | Other | FL | UHC OPTUM |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Doc@ultimatespine.com |
Other providers in Debary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.