Provider Demographics
NPI:1770798217
Name:JERDEB CHIROPRACTIC INC
Entity type:Organization
Organization Name:JERDEB CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-234-5268
Mailing Address - Street 1:2721 S PALM AIRE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4207
Mailing Address - Country:US
Mailing Address - Phone:954-935-3101
Mailing Address - Fax:
Practice Address - Street 1:1280 S POWERLINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4339
Practice Address - Country:US
Practice Address - Phone:954-234-5268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty