Provider Demographics
NPI:1083197461
Name:PARK AVENUE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PARK AVENUE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKELANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:CCPA
Authorized Official - Phone:561-848-3355
Mailing Address - Street 1:728 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2504
Mailing Address - Country:US
Mailing Address - Phone:561-848-3355
Mailing Address - Fax:
Practice Address - Street 1:728 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2504
Practice Address - Country:US
Practice Address - Phone:561-848-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty