Provider Demographics
NPI:1689695496
Name:INLINE CHIROPRACTIC GROUP INC
Entity Type:Organization
Organization Name:INLINE CHIROPRACTIC GROUP INC
Other - Org Name:INLINE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SLATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-491-4437
Mailing Address - Street 1:2740 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1677
Mailing Address - Country:US
Mailing Address - Phone:954-491-4437
Mailing Address - Fax:954-491-4492
Practice Address - Street 1:2740 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1677
Practice Address - Country:US
Practice Address - Phone:954-491-4437
Practice Address - Fax:954-491-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88180OtherBLUE CROSS BLUE SHIELD FL
FL88180OtherBLUE CROSS BLUE SHIELD FL