Provider Demographics
NPI:1376863753
Name:CLIFFORD FRUITHANDLER DC PA
Entity Type:Organization
Organization Name:CLIFFORD FRUITHANDLER DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUITHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:954-336-0776
Mailing Address - Street 1:8120 BLUE RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:954-336-0776
Mailing Address - Fax:954-755-9283
Practice Address - Street 1:8120 BLUE RIDGE LANE
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067
Practice Address - Country:US
Practice Address - Phone:954-336-0776
Practice Address - Fax:954-755-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR786AMedicare UPIN