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General NPI Number Information
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NPI Number | 1740582949
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AND INJURY CENTER, INC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 750 E SAMPLE RD BLDG 10# 6
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5144
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Country | US
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Telephone | 954-586-4907
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Fax | 954-586-4912
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Provider Business Mailing Address
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Address Line | 750 E SAMPLE ROAD BLDG 10# 6
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City | POMPANO BEACH
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State | FL
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Zip | 33064
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Country | US
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Telephone | 954-586-4907
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Fax | 954-586-4912
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. DOUGLAS D GAGNON
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Credential | DC
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Telephone | 954-586-4907
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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 | CH 8635
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License Number State | FL
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