Provider Demographics
NPI:1770096653
Name:ST. LUCIE INJURY AND HEALTH, LLC
Entity type:Organization
Organization Name:ST. LUCIE INJURY AND HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-882-0701
Mailing Address - Street 1:4842 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2243
Mailing Address - Country:US
Mailing Address - Phone:772-882-0701
Mailing Address - Fax:888-920-1114
Practice Address - Street 1:4842 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2243
Practice Address - Country:US
Practice Address - Phone:772-882-0701
Practice Address - Fax:888-920-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019857200Medicaid
8754334744OtherDOT ME#