Provider Demographics
NPI:1457426793
Name:COHEN, ERIC J (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 LAKE WORTH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1518
Mailing Address - Country:US
Mailing Address - Phone:561-641-1111
Mailing Address - Fax:561-296-0336
Practice Address - Street 1:6620 LAKE WORTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1518
Practice Address - Country:US
Practice Address - Phone:561-641-1111
Practice Address - Fax:561-296-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT88037Medicare UPIN
FL70780Medicare PIN