Provider Demographics
NPI:1821148115
Name:DR. LEE TRACHTENBERG D.C., P.A.
Entity Type:Organization
Organization Name:DR. LEE TRACHTENBERG D.C., P.A.
Other - Org Name:PLANTATION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TRACHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-792-3343
Mailing Address - Street 1:9877 FAIRWAY COVE LN
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2823
Mailing Address - Country:US
Mailing Address - Phone:954-423-9072
Mailing Address - Fax:954-475-9396
Practice Address - Street 1:7420 NW 5TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1611
Practice Address - Country:US
Practice Address - Phone:954-792-3343
Practice Address - Fax:954-792-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU 22777Medicare UPIN
FL22686AMedicare PIN