Provider Demographics
NPI:1689852915
Name:ABACOA TOWN CENTER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ABACOA TOWN CENTER CHIROPRACTIC INC
Other - Org Name:ABACOA PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-622-6111
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:561-622-1176
Practice Address - Street 1:3003 S CONGRESS AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2169
Practice Address - Country:US
Practice Address - Phone:561-963-6227
Practice Address - Fax:561-963-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3815790 00Medicaid
FLU93412Medicare UPIN
FL3815790 00Medicaid