Provider Demographics
NPI:1801996889
Name:ALIGN YOUR SPINE CHIROPRACTIC LIFE
Entity type:Organization
Organization Name:ALIGN YOUR SPINE CHIROPRACTIC LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASTRONARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-481-2828
Mailing Address - Street 1:4800 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4330
Mailing Address - Country:US
Mailing Address - Phone:954-481-2828
Mailing Address - Fax:954-481-2830
Practice Address - Street 1:4800 W HILLSBORO BLVD
Practice Address - Street 2:SUITE A-11
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4330
Practice Address - Country:US
Practice Address - Phone:954-481-2828
Practice Address - Fax:954-481-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6625030001Medicare NSC
FLK7303Medicare PIN