Provider Demographics
NPI:1760006043
Name:RESTORE INJURY HEALTH CENTER
Entity Type:Organization
Organization Name:RESTORE INJURY HEALTH CENTER
Other - Org Name:RESTORE INJURY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-259-9051
Mailing Address - Street 1:747 FAWN RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8268
Mailing Address - Country:US
Mailing Address - Phone:386-259-9051
Mailing Address - Fax:386-259-4243
Practice Address - Street 1:747 FAWN RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8268
Practice Address - Country:US
Practice Address - Phone:386-259-9051
Practice Address - Fax:386-259-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty