Provider Demographics
NPI:1407911910
Name:JUPITER SPINAL HEALTH CENTER
Entity type:Organization
Organization Name:JUPITER SPINAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRIMARY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-575-2444
Mailing Address - Street 1:103 S US HWY ONE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477
Mailing Address - Country:US
Mailing Address - Phone:561-575-2444
Mailing Address - Fax:561-744-8799
Practice Address - Street 1:103 S US HWY ONE
Practice Address - Street 2:SUITE B4
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477
Practice Address - Country:US
Practice Address - Phone:561-575-2444
Practice Address - Fax:561-744-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6340180001Medicare NSC
FL88345Medicare ID - Type UnspecifiedBCBS