Provider Demographics
NPI:1740214972
Name:LOPEZ CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:LOPEZ CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-541-4033
Mailing Address - Street 1:PO BOX 350725
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-0725
Mailing Address - Country:US
Mailing Address - Phone:305-541-4033
Mailing Address - Fax:305-541-6812
Practice Address - Street 1:3095 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4241
Practice Address - Country:US
Practice Address - Phone:305-541-4033
Practice Address - Fax:305-541-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88541OtherBLUE CROSS BLUE SHIELD
FL050676100Medicaid
FL88541Medicare ID - Type Unspecified