Provider Demographics
NPI:1083239354
Name:ATRINITY REHABILITATION AND CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ATRINITY REHABILITATION AND CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAGNY
Authorized Official - Middle Name:P
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-340-3815
Mailing Address - Street 1:1417 NW AVENUE L STE 5
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-1780
Mailing Address - Country:US
Mailing Address - Phone:561-340-3815
Mailing Address - Fax:
Practice Address - Street 1:1417 NW AVENUE L STE 5
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-1780
Practice Address - Country:US
Practice Address - Phone:561-340-3815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty