Provider Demographics
NPI:1497969703
Name:LATIN DIAGNOSTIC REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:LATIN DIAGNOSTIC REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:230-574-8241
Mailing Address - Street 1:603 DEL PRADO BLVD S STE A
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2637
Mailing Address - Country:US
Mailing Address - Phone:239-574-8241
Mailing Address - Fax:239-574-8251
Practice Address - Street 1:603 DEL PRADO BLVD S STE A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2637
Practice Address - Country:US
Practice Address - Phone:239-574-8241
Practice Address - Fax:239-574-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty