Provider Demographics
NPI:1700077963
Name:FLORIDA CHIROPRACTIC & SPORTS REHAB CENTER DAVIE, LLC
Entity Type:Organization
Organization Name:FLORIDA CHIROPRACTIC & SPORTS REHAB CENTER DAVIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-378-8285
Mailing Address - Street 1:8325 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3192
Mailing Address - Country:US
Mailing Address - Phone:954-378-8285
Mailing Address - Fax:954-451-3948
Practice Address - Street 1:350 N PINE ISLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1849
Practice Address - Country:US
Practice Address - Phone:954-378-8285
Practice Address - Fax:954-404-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7801111N00000X
FLCH9169111N00000X
FL9169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty