Provider Demographics
NPI:1376374405
Name:REALIGN CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:REALIGN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-512-1990
Mailing Address - Street 1:6245 MIRAMAR PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3964
Mailing Address - Country:US
Mailing Address - Phone:754-777-7936
Mailing Address - Fax:
Practice Address - Street 1:6245 MIRAMAR PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3964
Practice Address - Country:US
Practice Address - Phone:754-777-7936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty