Organization Active NPI

Tartack Chiropractic & Wellness Center Inc

  • Chiropractor
  • Fort Lauderdale, FL
National Provider Identifier
1104038066
Registry record updated Jan 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH0008769 Issued in FL
Legal business name
TARTACK CHIROPRACTIC & WELLNESS CENTER INC
Practice address
1222 S Andrews Ave
Suite 501
Fort Lauderdale, FL 33316-1806
Phone
(954) 764-4042
Fax
(954) 764-7275
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey S Tartack, D.C.NPI 1457423741
Title
Owner
Phone
(954) 764-4042

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CH0008769 FL Primary

Addresses

Primary practice location

1222 S Andrews Ave
Suite 501
Fort Lauderdale, FL 33316-1806

Mailing address

1222 S Andrews Ave
Suite 501
Fort Lauderdale, FL 33316-1806
Phone (954) 764-4042

Other identifiers 1

IdentifierTypeStateIssuer
382077700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070816000280 FL Part B Supplier - Clinic/Group Practice 5092807305 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Locations

1222 S Andrews Ave
Ste 501
Ft Lauderdale, FL 33316
Phone (954) 764-4042

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1104038066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 S ANDREWS AVE",
            "address_2": "SUITE 501",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161806",
            "telephone_number": "954-764-4042",
            "fax_number": "954-764-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 S ANDREWS AVE",
            "address_2": "SUITE 501",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161806",
            "telephone_number": "954-764-4042",
            "fax_number": "954-764-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARTACK CHIROPRACTIC & WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2015-01-16",
        "status": "A",
        "authorized_official_last_name": "TARTACK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-764-4042",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0008769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382077700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.