Provider Demographics
NPI:1134332091
Name:DQJS ENTERPRISES LLC
Entity Type:Organization
Organization Name:DQJS ENTERPRISES LLC
Other - Org Name:RENAISSANCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SLEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-2821
Mailing Address - Street 1:4212 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6252
Mailing Address - Country:US
Mailing Address - Phone:561-627-2821
Mailing Address - Fax:561-627-0542
Practice Address - Street 1:4212 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6252
Practice Address - Country:US
Practice Address - Phone:561-627-2821
Practice Address - Fax:561-627-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7713111N00000X
FLCH7901111N00000X
FLME0068339207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty