Provider Demographics
NPI:1811059637
Name:PEARL FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PEARL FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER, VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-5952
Mailing Address - Street 1:1457 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0702
Mailing Address - Country:US
Mailing Address - Phone:386-673-5952
Mailing Address - Fax:386-673-5953
Practice Address - Street 1:1457 N US HIGHWAY 1
Practice Address - Street 2:SUITE 21
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-0702
Practice Address - Country:US
Practice Address - Phone:386-673-5952
Practice Address - Fax:386-673-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty