Provider Demographics
NPI:1962887117
Name:PARK CHIROPRACTIC CARE, PA
Entity type:Organization
Organization Name:PARK CHIROPRACTIC CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPHIRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-532-6919
Mailing Address - Street 1:5412 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5209
Mailing Address - Country:US
Mailing Address - Phone:954-532-6919
Mailing Address - Fax:954-590-8650
Practice Address - Street 1:5412 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5209
Practice Address - Country:US
Practice Address - Phone:954-532-6919
Practice Address - Fax:954-590-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty