Provider Demographics
NPI:1649432378
Name:FLORIDA AUTO INJURY AND PAIN CENTER P L
Entity type:Organization
Organization Name:FLORIDA AUTO INJURY AND PAIN CENTER P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-748-2273
Mailing Address - Street 1:601 W INDIANTOWN RD
Mailing Address - Street 2:#2
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7525
Mailing Address - Country:US
Mailing Address - Phone:561-748-2273
Mailing Address - Fax:561-748-4856
Practice Address - Street 1:601 W INDIANTOWN RD
Practice Address - Street 2:#2
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7525
Practice Address - Country:US
Practice Address - Phone:561-748-2273
Practice Address - Fax:561-748-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7216305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821153875OtherNPI