Provider Demographics
NPI:1376694000
Name:PAINTER CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:PAINTER CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-421-9171
Mailing Address - Street 1:5002 N. FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FL
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-421-9171
Mailing Address - Fax:954-421-9191
Practice Address - Street 1:5002 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7057
Practice Address - Country:US
Practice Address - Phone:954-421-9171
Practice Address - Fax:954-421-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6650111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID