MEDICARE: ARIEL FOR LIFE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7733	FL

General Provider Information

NPI Number	:	1013125715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIEL FOR LIFE INC.

Provider Business Mailing Address
First Line	:	9541 AEGEAN DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2111
Country	:	US
Telephone Number	:	561-883-9129
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 NE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5532
Country	:	US
Telephone Number	:	561-276-2221
Fax Number	:	561-276-2474

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ELIAS FORMA
Credential	:	D.C.
Telephone Number	:	561-276-2221

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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Directions to “ARIEL FOR LIFE INC. ” Practice Location

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