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Organization
PROGRESSIVE CHIROPRACTIC AND REHABILITATION
Active
Organization
PROGRESSIVE CHIROPRACTIC AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL A. TATE D.C. (CHIROPRACTIC PHYSICIAN/OWNER)
(309) 830-9694
Entity
Organization
Contact information
Practice address
502 S MAIN ST, CRESTVIEW, FL 32536-4250
(850) 398-8640
(850) 398-8641
Mailing address
502 S MAIN ST, CRESTVIEW, FL 32536-4250
(850) 398-8640
(850) 398-8641
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH9929
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220C0
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
FL
01
—
CH9929
MEDICAL LICENSE
FL
Enumeration date
04/15/2014
Last updated
04/15/2014
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