Provider Demographics
NPI:1760586846
Name:WASSERMAN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:WASSERMAN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-755-1980
Mailing Address - Street 1:10394 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3942
Mailing Address - Country:US
Mailing Address - Phone:954-755-1980
Mailing Address - Fax:954-755-1994
Practice Address - Street 1:10394 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3942
Practice Address - Country:US
Practice Address - Phone:954-755-1980
Practice Address - Fax:954-755-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70368OtherBC/BS
FL70368Medicare ID - Type Unspecified
FLT94413Medicare UPIN