Provider Demographics
NPI: | 1437509965 |
---|---|
Name: | FIT FOR ACTION |
Entity Type: | Organization |
Organization Name: | FIT FOR ACTION |
Other - Org Name: | FIT FOR ACTION |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRES |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DIEGO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KOSTZER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 954-432-5775 |
Mailing Address - Street 1: | 9469 SHERIDAN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HOLLYWOOD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33024-8561 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-432-5775 |
Mailing Address - Fax: | 954-432-2525 |
Practice Address - Street 1: | 9469 SHERIDAN ST |
Practice Address - Street 2: | |
Practice Address - City: | HOLLYWOOD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33024-8561 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-432-5775 |
Practice Address - Fax: | 954-432-2525 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-06-15 |
Last Update Date: | 2018-03-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | CH8420 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |