Provider Demographics
NPI:1376131813
Name:GENESIS PAIN MANAGEMENT
Entity Type:Organization
Organization Name:GENESIS PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-990-4227
Mailing Address - Street 1:3317 NW 10TH TER STE 406
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5941
Mailing Address - Country:US
Mailing Address - Phone:954-990-4227
Mailing Address - Fax:954-990-6334
Practice Address - Street 1:3317 NW 10TH TER STE 406
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5941
Practice Address - Country:US
Practice Address - Phone:954-990-4227
Practice Address - Fax:954-990-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty