Provider Demographics
NPI:1043350887
Name:BARTELL CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:BARTELL CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-426-3200
Mailing Address - Street 1:57 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3429
Mailing Address - Country:US
Mailing Address - Phone:954-426-3200
Mailing Address - Fax:954-570-9587
Practice Address - Street 1:57 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3429
Practice Address - Country:US
Practice Address - Phone:954-426-3200
Practice Address - Fax:954-570-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
135470581954OtherHUMANA
T55854Medicare UPIN
88493Medicare ID - Type Unspecified