Provider Demographics
NPI:1255567970
Name:PINE CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:PINE CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-782-7006
Mailing Address - Street 1:611 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6343
Mailing Address - Country:US
Mailing Address - Phone:954-782-7006
Mailing Address - Fax:954-782-0246
Practice Address - Street 1:611 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6343
Practice Address - Country:US
Practice Address - Phone:954-782-7006
Practice Address - Fax:954-782-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty