Provider Demographics
NPI:1871872754
Name:ANCONA, CHRISTOPHER LOREN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LOREN
Last Name:ANCONA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22415 SW 61 WAY A202
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:561-306-4284
Mailing Address - Fax:954-472-7941
Practice Address - Street 1:10078 NW 1ST CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7035
Practice Address - Country:US
Practice Address - Phone:954-472-7975
Practice Address - Fax:954-472-7941
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor