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General NPI Number Information
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NPI Number | 1184928400
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Entity Type | Organization
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Legal Business Name | FORT LAUDERDALE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 200 SE 12TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1816
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Country | US
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Telephone | 954-463-2404
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Fax | 954-463-2307
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Provider Business Mailing Address
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Address Line | 200 SE 12TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1816
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Country | US
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Telephone | 954-463-2404
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Fax | 954-463-2307
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAYNE W WHITE
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Credential | D.C.
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Telephone | 954-463-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0006397
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License Number State | FL
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