Provider Demographics
NPI:1295009629
Name:CUTLER RIDGE FAMILY CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:CUTLER RIDGE FAMILY CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERSON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-255-3005
Mailing Address - Street 1:10700 CARIBBEAN BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:305-255-3005
Mailing Address - Fax:305-255-7689
Practice Address - Street 1:10700 CARIBBEAN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1232
Practice Address - Country:US
Practice Address - Phone:305-255-3005
Practice Address - Fax:305-255-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty