NPIMap

Organization Active NPI

Fort Myers Chiropractic & Nutrition Center, Inc.

  • Chiropractor
  • Fort Myers, FL
National Provider Identifier
1396126900
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH0006852 Issued in FL
Legal business name
FORT MYERS CHIROPRACTIC & NUTRITION CENTER, INC.
Practice address
1429 Colonial Blvd
Suite 101
Fort Myers, FL 33907-1067
Phone
(239) 939-3338
Fax
(239) 939-5821
NPI assigned
Jun 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Bradley Wayne Price, D.C.NPI 1588630701
Title
Owner/President
Phone
(239) 939-3338

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH0006852 FL Primary

Addresses

Primary practice location

1429 Colonial Blvd
Suite 101
Fort Myers, FL 33907-1067

Mailing address

1429 Colonial Blvd
Suite 101
Fort Myers, FL 33907-1067
Phone (239) 939-3338

Other identifiers 1

IdentifierTypeStateIssuer
381118200MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150820011257 FL Part B Supplier - Clinic/Group Practice 3274848106 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

1429 Colonial Blvd
Ste 101
Fort Myers, FL 33907
Phone (239) 939-3338

Practitioners & affiliated clinicians

Practitioners 8

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": "1433894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1396126900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1429 COLONIAL BLVD",
            "address_2": "SUITE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071067",
            "telephone_number": "239-939-3338",
            "fax_number": "239-939-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1429 COLONIAL BLVD",
            "address_2": "SUITE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071067",
            "telephone_number": "239-939-3338",
            "fax_number": "239-939-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS CHIROPRACTIC & NUTRITION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-10",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "239-939-3338",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0006852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381118200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; 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.