Provider Demographics
NPI:1972621324
Name:PERSONAL CHIROPRACTIC CARE CENTER INC.
Entity Type:Organization
Organization Name:PERSONAL CHIROPRACTIC CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-758-9550
Mailing Address - Street 1:8025 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4620
Mailing Address - Country:US
Mailing Address - Phone:305-758-9550
Mailing Address - Fax:305-758-9430
Practice Address - Street 1:8025 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4620
Practice Address - Country:US
Practice Address - Phone:305-758-9550
Practice Address - Fax:305-758-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5778111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050891800Medicaid
22376(K2615)Medicare ID - Type Unspecified