Provider Demographics
NPI:1558487280
Name:P.F.G CHIROPRACTIC PAIN CENTER
Entity Type:Organization
Organization Name:P.F.G CHIROPRACTIC PAIN CENTER
Other - Org Name:P.F.G CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANCHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-574-3948
Mailing Address - Street 1:2400 SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3300
Mailing Address - Country:US
Mailing Address - Phone:407-574-3948
Mailing Address - Fax:
Practice Address - Street 1:2400 SILVER STAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3300
Practice Address - Country:US
Practice Address - Phone:407-574-3948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 7468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty