Provider Demographics
NPI:1992839047
Name:POWERLINE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:POWERLINE CHIROPRACTIC, INC.
Other - Org Name:CHIROPRACTIC ASSOCIATES OF POMPANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-590-3580
Mailing Address - Street 1:911 E ATLANTIC BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7372
Mailing Address - Country:US
Mailing Address - Phone:954-590-3580
Mailing Address - Fax:954-941-0405
Practice Address - Street 1:911 E ATLANTIC BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7372
Practice Address - Country:US
Practice Address - Phone:954-590-3580
Practice Address - Fax:954-941-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty