Provider Demographics
NPI:1962796417
Name:HOMESTEAD PAIN & INJURY CENTER INC
Entity type:Organization
Organization Name:HOMESTEAD PAIN & INJURY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-242-7590
Mailing Address - Street 1:103 E LUCY ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2501
Mailing Address - Country:US
Mailing Address - Phone:305-242-7590
Mailing Address - Fax:305-245-5794
Practice Address - Street 1:103 E LUCY ST
Practice Address - Street 2:SUITE 135
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2501
Practice Address - Country:US
Practice Address - Phone:305-242-7590
Practice Address - Fax:305-245-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty