Healthcare Provider Details

I. General information

NPI: 1942479001
Provider Name (Legal Business Name): ST. LUCIE INJURY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 S US HIGHWAY 1
FORT PIERCE FL
34982-7078
US

IV. Provider business mailing address

4731 W ATLANTIC AVE SUITE B 21
DELRAY BEACH FL
33445-3897
US

V. Phone/Fax

Practice location:
  • Phone: 772-489-8867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8098
License Number StateFL

VIII. Authorized Official

Name: ROBERT RAY SITNER
Title or Position: PRES
Credential:
Phone: 561-495-1212