Provider Demographics
NPI:1154876811
Name:ESSENTIAL HEALTH OF WESTON
Entity type:Organization
Organization Name:ESSENTIAL HEALTH OF WESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-389-5507
Mailing Address - Street 1:15830 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1212
Mailing Address - Country:US
Mailing Address - Phone:954-389-5507
Mailing Address - Fax:
Practice Address - Street 1:15830 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1212
Practice Address - Country:US
Practice Address - Phone:954-389-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780740290OtherNPI