Provider Demographics
NPI:1295778975
Name:CONGRESSCHIROPRACTIC CENTER
Entity type:Organization
Organization Name:CONGRESSCHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-433-8999
Mailing Address - Street 1:2326 S. CONGRESS AVENUE
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-433-8999
Mailing Address - Fax:561-828-0431
Practice Address - Street 1:2326 S. CONGRESS AVENUE
Practice Address - Street 2:SUITE 2-C
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-433-8999
Practice Address - Fax:561-828-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty