Provider Demographics
NPI:1043342512
Name:BACUS CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BACUS CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MORE
Authorized Official - Last Name:MANIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-957-7500
Mailing Address - Street 1:2706 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2551
Mailing Address - Country:US
Mailing Address - Phone:954-957-7500
Mailing Address - Fax:954-957-7040
Practice Address - Street 1:2706 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2551
Practice Address - Country:US
Practice Address - Phone:954-957-7500
Practice Address - Fax:954-957-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8425111N00000X
FLOS8239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K6949Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER