Provider Demographics
NPI:1588797393
Name:MONA ISSA CHIROPRACTIC AND WELLNESS CENTER
Entity type:Organization
Organization Name:MONA ISSA CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:954-880-0101
Mailing Address - Street 1:11200 PINES BLVD
Mailing Address - Street 2:#101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4139
Mailing Address - Country:US
Mailing Address - Phone:954-880-0101
Mailing Address - Fax:
Practice Address - Street 1:11200 PINES BLVD
Practice Address - Street 2:#101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4139
Practice Address - Country:US
Practice Address - Phone:954-880-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty