Provider Demographics
NPI:1811227465
Name:LIGHTHOUSE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LIGHTHOUSE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-933-3839
Mailing Address - Street 1:3102 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6738
Mailing Address - Country:US
Mailing Address - Phone:954-933-3839
Mailing Address - Fax:954-933-3836
Practice Address - Street 1:3102 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6738
Practice Address - Country:US
Practice Address - Phone:954-933-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty