Provider Demographics
NPI:1871773820
Name:DR. SEAN L. PRICE, PA
Entity type:Organization
Organization Name:DR. SEAN L. PRICE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-862-2224
Mailing Address - Street 1:745C BEAL PKWY NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3093
Mailing Address - Country:US
Mailing Address - Phone:850-862-2224
Mailing Address - Fax:850-862-2204
Practice Address - Street 1:745C BEAL PKWY NW
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3093
Practice Address - Country:US
Practice Address - Phone:850-862-2224
Practice Address - Fax:850-862-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89671ZOtherMEDICARE ID TYPE UNSPECIF
FL89671OtherBLUE CROSS BLUE SHIELD
FLCH8813Medicare UPIN
FL89671ZOtherMEDICARE ID TYPE UNSPECIF