Provider Demographics
NPI:1053377275
Name:CHEATWOOD, CHRIS W (DC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:W
Last Name:CHEATWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4737
Mailing Address - Country:US
Mailing Address - Phone:863-680-1064
Mailing Address - Fax:863-680-1734
Practice Address - Street 1:737 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4737
Practice Address - Country:US
Practice Address - Phone:863-680-1064
Practice Address - Fax:863-680-1734
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350042466OtherRAILROAD RETIREMENT BOARD
FLCH5887OtherSTATE LICENSE NUMBER
FL22378Medicare PIN
FLT87794Medicare UPIN