Provider Demographics
NPI:1174863039
Name:FAMILY CHIROPRACTIC CENTER OF MARTIN COUNTY, INC.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF MARTIN COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-288-2527
Mailing Address - Street 1:526 SE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3045
Mailing Address - Country:US
Mailing Address - Phone:772-288-2527
Mailing Address - Fax:772-288-2552
Practice Address - Street 1:526 SE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3045
Practice Address - Country:US
Practice Address - Phone:772-288-2527
Practice Address - Fax:772-288-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006009111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU25971Medicare UPIN
FL22500Medicare PIN