Provider Demographics
NPI:1538491881
Name:COMFORT CHIROPRACTIC PA
Entity Type:Organization
Organization Name:COMFORT CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:POTTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-486-4199
Mailing Address - Street 1:709F SEBASTIAN BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4375
Mailing Address - Country:US
Mailing Address - Phone:772-663-2227
Mailing Address - Fax:772-872-5225
Practice Address - Street 1:709 SEBASTIAN BLVD STE F
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-8704
Practice Address - Country:US
Practice Address - Phone:772-663-2227
Practice Address - Fax:772-872-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty