Provider Demographics
NPI:1235872094
Name:NEURO CIRCUIT CENTERS LLC
Entity Type:Organization
Organization Name:NEURO CIRCUIT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSEBOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-410-2999
Mailing Address - Street 1:10650 W STATE ROAD 84 STE 208
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-410-2999
Mailing Address - Fax:
Practice Address - Street 1:10650 W STATE ROAD 84 STE 208
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-410-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty