Provider Demographics
NPI:1346456167
Name:DOCTOR'S PROFESSIONAL SERVICES CONSULTANTS, INC
Entity Type:Organization
Organization Name:DOCTOR'S PROFESSIONAL SERVICES CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-615-0801
Mailing Address - Street 1:2682 SE WILLOUGHBY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4738
Mailing Address - Country:US
Mailing Address - Phone:386-615-0801
Mailing Address - Fax:386-672-4811
Practice Address - Street 1:2682 SE WILLOUGHBY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4738
Practice Address - Country:US
Practice Address - Phone:386-615-0801
Practice Address - Fax:386-672-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85927Medicare UPIN
FL88986Medicare ID - Type Unspecified