Provider Demographics
NPI:1477653756
Name:DELRAY MODERN CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:DELRAY MODERN CHIROPRACTIC CENTER PA
Other - Org Name:DELRAY MODERN CHIROPRACTIC CENTER & MASSAGE THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR/OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAPNEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-274-0395
Mailing Address - Street 1:1050 S FEDERAL HWY
Mailing Address - Street 2:SUITE 145
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5134
Mailing Address - Country:US
Mailing Address - Phone:561-274-0395
Mailing Address - Fax:561-278-2399
Practice Address - Street 1:1050 S FEDERAL HWY
Practice Address - Street 2:SUITE 145
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5134
Practice Address - Country:US
Practice Address - Phone:561-274-0395
Practice Address - Fax:561-278-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX IDENTIFICATION NUMBER
FL=========OtherTAX IDENTIFICATION NUMBER