Estero Family Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH10733 Issued in FL

Legal business name

ESTERO FAMILY CHIROPRACTIC LLC

Practice address

21740 S Tamiami TRL Ste 103
Estero, FL 33928-2819

Phone

(815) 252-9783

NPI assigned

Oct 26, 2012

Last updated

Oct 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lawrence Clifford Wallen III, DCNPI 1295050516

Title

Owner/Chiropractor

Phone

(815) 252-9783

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Port Charlotte Chiropractic LLC

  • Chiropractor
  • Port Charlotte, FL
  • NPI 1356090245

  Member Of

  NPD member

Locations

Practitioners 3

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.

• Lawrence Clifford Wallen III, D.C.

  • Chiropractor
  • Estero, FL
  • NPI 1295050516
  Medicare reassignment NPD Authorized official
• Efthimios T Peristeridis, D.C.

  • Chiropractor
  • Estero, FL
  • NPI 1356443345
  Medicare reassignment NPD
• Jeffrey M Gorbach, D.C.

  • Chiropractor
  • Comstock Park, MI
  • NPI 1265748131
  NPD (past)

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1679826705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21740 S TAMIAMI TRL STE 103",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339282819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21740 S TAMIAMI TRL STE 103",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339282819",
            "telephone_number": "815-252-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTERO FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "WALLEN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "CLIFFORD",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "815-252-9783",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH10733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ovieda Perra Elliott, MA
• Sarah Escamilla, RN, IBCLC
• Estero Bay Dental, PLLC
• Estero Dermatology & Skin Surgery Center, LLC (Houck Dermatology)
• Estero Eyecare
• Estero General Dentistry LLC (Coastal Smiles)
• Estero Retina
• Estero Smiles Dentistry, PA (Estero Smiles Dentistry)
• Ernesto Alberto Eusebio Morales, M.D.
• Elyse Dyan Ewig, AUD

• Chiropractor in Estero, FL
• Providers in Estero, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; 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.