Provider Demographics
NPI:1124305107
Name:ATLANTIC CHIROPRACTIC STUDIO
Entity type:Organization
Organization Name:ATLANTIC CHIROPRACTIC STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MARIE- LINDA
Authorized Official - Last Name:LABARGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-768-3327
Mailing Address - Street 1:800 PALM TRL
Mailing Address - Street 2:210
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5877
Mailing Address - Country:US
Mailing Address - Phone:561-272-2228
Mailing Address - Fax:561-272-2240
Practice Address - Street 1:800 PALM TRL
Practice Address - Street 2:210
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5877
Practice Address - Country:US
Practice Address - Phone:561-272-2228
Practice Address - Fax:561-272-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty