Provider Demographics
NPI:1184783649
Name:FAMILY HEALTH & WELLNESS CENTER OF PEMBROKE PINES INC.LIFE CHIROPRACTI
Entity type:Organization
Organization Name:FAMILY HEALTH & WELLNESS CENTER OF PEMBROKE PINES INC.LIFE CHIROPRACTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-432-5433
Mailing Address - Street 1:9960 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6139
Mailing Address - Country:US
Mailing Address - Phone:954-432-5433
Mailing Address - Fax:
Practice Address - Street 1:9960 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6139
Practice Address - Country:US
Practice Address - Phone:954-432-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39594OtherBLUE CROSS & BLUE SHIELD
FLK6155Medicare PIN