Provider Demographics
NPI:1295345932
Name:HOUSECALLSPINEDOCTOR-COM LLC
Entity type:Organization
Organization Name:HOUSECALLSPINEDOCTOR-COM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:800-315-7611
Mailing Address - Street 1:221 W HALLANDALE BEACH BLVD # 346
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5441
Mailing Address - Country:US
Mailing Address - Phone:800-315-7611
Mailing Address - Fax:305-723-3334
Practice Address - Street 1:221 W HALLANDALE BEACH BLVD # 346
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5441
Practice Address - Country:US
Practice Address - Phone:800-315-7611
Practice Address - Fax:305-723-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty