Organization
JOHN R ISTAD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R ISTAD DC (OWNER)
(772) 398-5400
Entity
Organization
Contact information
Practice address
1105 SE PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL 34952-5332
(772) 398-5400
(772) 398-6600
Mailing address
1105 SE PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL 34952-5332
(772) 398-5400
(772) 398-6600
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
CH6232
FL
Other
Enumeration date
12/20/2010
Last updated
03/11/2011
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