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Organization
LIFE CHIROPRACTIC CENTER PA
Active
Organization
LIFE CHIROPRACTIC CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN NATHANIEL RUKEYSER D.C. (CLINIC DIRECTOR)
(772) 398-8888
Entity
Organization
Contact information
Practice address
1230 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5330
(772) 398-8888
Mailing address
1230 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5330
(772) 398-8888
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH8717
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
381887000
—
FL
01
—
74769
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/05/2007
Last updated
09/05/2007
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