Provider Demographics
NPI:1275608515
Name:ERIC J COHEN DC PA
Entity type:Organization
Organization Name:ERIC J COHEN DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-563-4472
Mailing Address - Street 1:6620 LAKE WORTH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1518
Mailing Address - Country:US
Mailing Address - Phone:561-641-1111
Mailing Address - Fax:561-296-0336
Practice Address - Street 1:6620 LAKE WORTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1518
Practice Address - Country:US
Practice Address - Phone:561-641-1111
Practice Address - Fax:561-296-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty