Healthcare Provider Details

I. General information

NPI: 1770096653
Provider Name (Legal Business Name): ST. LUCIE INJURY AND HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 N KINGS HWY
FORT PIERCE FL
34951-2243
US

IV. Provider business mailing address

4842 N KINGS HWY
FORT PIERCE FL
34951-2243
US

V. Phone/Fax

Practice location:
  • Phone: 772-882-0701
  • Fax: 888-920-1114
Mailing address:
  • Phone: 772-882-0701
  • Fax: 888-920-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN PARKER SANDERS
Title or Position: CEO
Credential: DC
Phone: 772-882-0701