Provider Demographics
NPI:1093527129
Name:DIVINE UC CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:DIVINE UC CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:VINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-902-9009
Mailing Address - Street 1:250 E EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4874
Mailing Address - Country:US
Mailing Address - Phone:321-241-4801
Mailing Address - Fax:
Practice Address - Street 1:250 E EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4874
Practice Address - Country:US
Practice Address - Phone:321-241-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty