Provider Demographics
NPI:1376883207
Name:SIEGAL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SIEGAL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-624-3003
Mailing Address - Street 1:5600 PGA BLVD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3900
Mailing Address - Country:US
Mailing Address - Phone:561-624-3003
Mailing Address - Fax:561-624-4349
Practice Address - Street 1:5600 PGA BLVD
Practice Address - Street 2:SUITE 104A
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3900
Practice Address - Country:US
Practice Address - Phone:561-624-3003
Practice Address - Fax:561-624-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7014261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU56551Medicare UPIN