Healthcare Provider Details

I. General information

NPI: 1447562111
Provider Name (Legal Business Name): KUTLUC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 S UNIVERSITY DR
DAVIE FL
33324-5813
US

IV. Provider business mailing address

2215 S UNIVERSITY DR
DAVIE FL
33324-5813
US

V. Phone/Fax

Practice location:
  • Phone: 954-547-8223
  • Fax: 954-473-5993
Mailing address:
  • Phone: 954-547-8223
  • Fax: 954-473-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RONALD A TAWFIK
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 954-547-8223