Provider Demographics
NPI:1053696864
Name:WEST PINES HEALTH CENTER, PA
Entity type:Organization
Organization Name:WEST PINES HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-655-7246
Mailing Address - Street 1:7797 N. UNIVERSITY DR.
Mailing Address - Street 2:#101
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-655-7246
Mailing Address - Fax:
Practice Address - Street 1:20170 PINES BLVD.
Practice Address - Street 2:#101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:965-655-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty