Provider Demographics
NPI:1457481285
Name:CARLSTROM FAMILY CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:CARLSTROM FAMILY CHIROPRACTIC CENTER PA
Other - Org Name:SPINE DESIGN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:TROISE
Authorized Official - Last Name:CARLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-741-1316
Mailing Address - Street 1:1102 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6813
Mailing Address - Country:US
Mailing Address - Phone:561-741-1316
Mailing Address - Fax:561-741-1375
Practice Address - Street 1:1102 W INDIANTOWN RD
Practice Address - Street 2:SUITE 11
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6813
Practice Address - Country:US
Practice Address - Phone:561-741-1316
Practice Address - Fax:561-741-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38170OtherBCBS GROUP PIN
FL38170OtherBCBS GROUP PIN