Provider Demographics
NPI:1053879163
Name:PROHEALTH CHIROPRACTIC & INJURY CENTER CORP.
Entity type:Organization
Organization Name:PROHEALTH CHIROPRACTIC & INJURY CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-842-2384
Mailing Address - Street 1:19451 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1653
Mailing Address - Country:US
Mailing Address - Phone:954-842-2384
Mailing Address - Fax:
Practice Address - Street 1:19451 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1653
Practice Address - Country:US
Practice Address - Phone:954-638-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty