Basic Information
| Provider Information | |||||||||
| NPI: | 1861680985 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HALIFAX CHIROPRACTIC ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 PERGOLA PL | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321741058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526720712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 807 BEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321191824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864927931 | ||||||||
| FaxNumber: | 3864927933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2007 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOWE | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3526720712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 9358 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.