Provider Demographics
NPI:1255989992
Name:100 PERCENT CHIROPRACTIC SUPR, LLC
Entity type:Organization
Organization Name:100 PERCENT CHIROPRACTIC SUPR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAELEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-430-7433
Mailing Address - Street 1:300 CENTER DR STE E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8633
Mailing Address - Country:US
Mailing Address - Phone:561-430-7433
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8633
Practice Address - Country:US
Practice Address - Phone:561-430-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811306806Medicaid