Provider Demographics
NPI:1629778113
Name:PRIME IMPACT CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:PRIME IMPACT CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:UKEAGU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-415-5931
Mailing Address - Street 1:321 MISTY OAKS RUN
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2817
Mailing Address - Country:US
Mailing Address - Phone:954-415-5931
Mailing Address - Fax:
Practice Address - Street 1:100 E SYBELIA AVE STE 217
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4757
Practice Address - Country:US
Practice Address - Phone:407-887-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty