Provider Demographics
NPI:1003182676
Name:POULOS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:POULOS CHIROPRACTIC, LLC
Other - Org Name:FLORIDA SPINE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-252-3100
Mailing Address - Street 1:727 NORTHLAKE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5242
Mailing Address - Country:US
Mailing Address - Phone:561-904-6066
Mailing Address - Fax:561-904-6076
Practice Address - Street 1:727 NORTHLAKE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5242
Practice Address - Country:US
Practice Address - Phone:561-904-6066
Practice Address - Fax:561-904-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty