Provider Demographics
NPI:1902028764
Name:ALL STAR MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:ALL STAR MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-549-6333
Mailing Address - Street 1:1314 CAPE CORAL PKWY E
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9696
Mailing Address - Country:US
Mailing Address - Phone:239-549-6333
Mailing Address - Fax:239-549-6304
Practice Address - Street 1:1314 CAPE CORAL PKWY E
Practice Address - Street 2:SUITE # 210
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9696
Practice Address - Country:US
Practice Address - Phone:239-549-6333
Practice Address - Fax:239-549-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH5345OtherCHIROPRACTOR