Healthcare Provider Details

I. General information

NPI: 1669864005
Provider Name (Legal Business Name): JOSEPH FISCHETTI, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 W ATLANTIC BLVD SUITE 103
POMPANO BEACH FL
33069-2625
US

IV. Provider business mailing address

2755 W ATLANTIC BLVD SUITE 103
POMPANO BEACH FL
33069-2625
US

V. Phone/Fax

Practice location:
  • Phone: 754-220-8781
  • Fax: 754-220-8782
Mailing address:
  • Phone: 754-220-8781
  • Fax: 754-220-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberME83875
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10272
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEPH FISCHETTI
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 754-220-8781