Provider Demographics
NPI:1154556157
Name:CRESTHAVEN CHIROPRACTIC CENTRE, INC
Entity type:Organization
Organization Name:CRESTHAVEN CHIROPRACTIC CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-439-2550
Mailing Address - Street 1:2601 S MILITARY TRL
Mailing Address - Street 2:SUITE 34
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7510
Mailing Address - Country:US
Mailing Address - Phone:561-439-2550
Mailing Address - Fax:561-439-2992
Practice Address - Street 1:2601 S MILITARY TRL
Practice Address - Street 2:SUITE 34
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7510
Practice Address - Country:US
Practice Address - Phone:561-439-2550
Practice Address - Fax:561-439-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty