Provider Demographics
NPI:1679307110
Name:INDELICATO CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:INDELICATO CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:FRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-746-2612
Mailing Address - Street 1:407 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1927
Mailing Address - Country:US
Mailing Address - Phone:941-746-2612
Mailing Address - Fax:
Practice Address - Street 1:407 6TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1927
Practice Address - Country:US
Practice Address - Phone:941-746-2612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service