Provider Demographics
NPI:1235176314
Name:PASULA, JACK S (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:S
Last Name:PASULA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1401
Mailing Address - Country:US
Mailing Address - Phone:561-483-3900
Mailing Address - Fax:561-483-5554
Practice Address - Street 1:1883 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1401
Practice Address - Country:US
Practice Address - Phone:561-483-3900
Practice Address - Fax:561-483-5554
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA60758OtherBLUE CROSS BLUE SHIELD
FLNELF9OtherBCBS FL
FLU7747XMedicare PIN