Healthcare Provider Details

I. General information

NPI: 1174863039
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CENTER OF MARTIN COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SE DIXIE HWY
STUART FL
34994-3045
US

IV. Provider business mailing address

526 SE DIXIE HWY
STUART FL
34994-3045
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2527
  • Fax: 772-288-2552
Mailing address:
  • Phone: 772-288-2527
  • Fax: 772-288-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH0006009
License Number StateFL

VIII. Authorized Official

Name: LISA M LUST
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 772-288-2527