Provider Demographics
NPI:1013327832
Name:NECK PAIN BACK PAIN AND HEADACHE RELIEF CENTER OF FT. MYERS, LLC
Entity Type:Organization
Organization Name:NECK PAIN BACK PAIN AND HEADACHE RELIEF CENTER OF FT. MYERS, LLC
Other - Org Name:LUCE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:CAIL
Authorized Official - Last Name:RAFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-253-8362
Mailing Address - Street 1:4144 CLEVELAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-939-9796
Mailing Address - Fax:239-939-9609
Practice Address - Street 1:4144 CLEVELAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-939-9796
Practice Address - Fax:239-939-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV04539Medicare UPIN