Provider Demographics
NPI:1306248745
Name:DAVID J PINE, DC
Entity type:Organization
Organization Name:DAVID J PINE, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-782-7006
Mailing Address - Street 1:611 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6343
Mailing Address - Country:US
Mailing Address - Phone:954-782-7006
Mailing Address - Fax:
Practice Address - Street 1:611 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6343
Practice Address - Country:US
Practice Address - Phone:954-782-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002853261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
005L4OtherFLORIDA BLUE