Provider Demographics
NPI:1679391635
Name:FUNCTIONALLY FIT CHIROPRACTIC INC.
Entity type:Organization
Organization Name:FUNCTIONALLY FIT CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-877-2090
Mailing Address - Street 1:3802 MURRELL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4741
Mailing Address - Country:US
Mailing Address - Phone:321-877-2090
Mailing Address - Fax:321-349-0217
Practice Address - Street 1:3802 MURRELL RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4741
Practice Address - Country:US
Practice Address - Phone:321-877-2090
Practice Address - Fax:321-349-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1679391635OtherCHIROPRACTOR