Provider Demographics
NPI:1659655066
Name:ABL INTEGRATED HEALTH CENTER PSL, PA
Entity Type:Organization
Organization Name:ABL INTEGRATED HEALTH CENTER PSL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TUCKER
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-879-3255
Mailing Address - Street 1:286 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3341
Mailing Address - Country:US
Mailing Address - Phone:954-452-4600
Mailing Address - Fax:954-452-4652
Practice Address - Street 1:549 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1606
Practice Address - Country:US
Practice Address - Phone:772-879-3255
Practice Address - Fax:772-879-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70255Medicare UPIN