Healthcare Provider Details

I. General information

NPI: 1154394641
Provider Name (Legal Business Name): JEFFEREY HAZIM CHIROPRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 POWERLINE RD
FORT LAUDERDALE FL
33309-2067
US

IV. Provider business mailing address

6555 POWERLINE RD
FORT LAUDERDALE FL
33309-2048
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-1880
  • Fax: 954-776-1880
Mailing address:
  • Phone: 954-776-1880
  • Fax: 954-776-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH-7927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: