Provider Demographics
NPI:1922376664
Name:JACK L. EPTER D.C. P. A. DBA EPTER CHIROPRACTIC
Entity Type:Organization
Organization Name:JACK L. EPTER D.C. P. A. DBA EPTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:EPTER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:561-575-4400
Mailing Address - Street 1:100 W INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3530
Mailing Address - Country:US
Mailing Address - Phone:561-575-4400
Mailing Address - Fax:
Practice Address - Street 1:100 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3530
Practice Address - Country:US
Practice Address - Phone:561-575-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00004296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22326Medicare UPIN