Provider Demographics
NPI:1740582949
Name:CHIROPRACTIC AND INJURY CENTER, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND INJURY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-586-4907
Mailing Address - Street 1:750 E SAMPLE ROAD
Mailing Address - Street 2:BLDG 10# 6
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-586-4907
Mailing Address - Fax:954-586-4912
Practice Address - Street 1:750 E SAMPLE RD
Practice Address - Street 2:BLDG 10# 6
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5144
Practice Address - Country:US
Practice Address - Phone:954-586-4907
Practice Address - Fax:954-586-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherNPI 1306962378