Provider Demographics
NPI:1659540052
Name:MIDWAY MEDICAL TWO PA
Entity Type:Organization
Organization Name:MIDWAY MEDICAL TWO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-720-1040
Mailing Address - Street 1:5859 NORTH UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-720-1040
Mailing Address - Fax:954-720-4411
Practice Address - Street 1:5859 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-720-1040
Practice Address - Fax:954-720-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty