Provider Demographics
NPI:1871716597
Name:ISNER CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:ISNER CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:ISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-852-0110
Mailing Address - Street 1:1103 NATURE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7454
Mailing Address - Country:US
Mailing Address - Phone:386-788-2596
Mailing Address - Fax:
Practice Address - Street 1:1515 HERBERT ST STE 209
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6105
Practice Address - Country:US
Practice Address - Phone:386-767-7510
Practice Address - Fax:386-767-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty