Provider Demographics
NPI:1669864005
Name:JOSEPH FISCHETTI, PA
Entity Type:Organization
Organization Name:JOSEPH FISCHETTI, PA
Other - Org Name:NON-INVASIVE SPINE AND PAIN CENTER (NSPC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:754-220-8781
Mailing Address - Street 1:2755 W ATLANTIC BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2625
Mailing Address - Country:US
Mailing Address - Phone:754-220-8781
Mailing Address - Fax:754-220-8782
Practice Address - Street 1:2755 W ATLANTIC BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2625
Practice Address - Country:US
Practice Address - Phone:754-220-8781
Practice Address - Fax:754-220-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10272111N00000X
FLME838752081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008CEOtherBLUE CROSS BLUE SHIELD