Healthcare Provider Details

I. General information

NPI: 1740654474
Provider Name (Legal Business Name): PROFESSIONAL CO-OP SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W DANIA BEACH BLVD
DANIA FL
33004-3330
US

IV. Provider business mailing address

850 W DANIA BEACH BLVD
DANIA FL
33004-3330
US

V. Phone/Fax

Practice location:
  • Phone: 866-999-4041
  • Fax: 866-999-9175
Mailing address:
  • Phone: 866-999-4041
  • Fax: 866-999-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DAVID CAPLINGER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 866-999-4041