Provider Demographics
NPI:1942479001
Name:ST. LUCIE INJURY CENTER INC.
Entity Type:Organization
Organization Name:ST. LUCIE INJURY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-495-1212
Mailing Address - Street 1:4731 W ATLANTIC AVE
Mailing Address - Street 2:SUITE B 21
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4816 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7078
Practice Address - Country:US
Practice Address - Phone:772-489-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty