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General NPI Number Information
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NPI Number | 1801996889
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Entity Type | Organization
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Legal Business Name | ALIGN YOUR SPINE CHIROPRACTIC LIFE
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 4800 W HILLSBORO BLVD SUITE A-11
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4330
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Country | US
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Telephone | 954-481-2828
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Fax | 954-481-2830
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Provider Business Mailing Address
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Address Line | 4800 W HILLSBORO BLVD SUITE A-11
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4330
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Country | US
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Telephone | 954-481-2828
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Fax | 954-481-2830
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN J MASTRONARDI
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Credential | DC
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Telephone | 954-481-2828
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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 | CH8918
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License Number State | FL
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