MEDICARE: CHIROMEDIC MOBILE DIAGNOSTIC 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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1063631703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROMEDIC MOBILE DIAGNOSTIC INC.

Provider Business Mailing Address
First Line	:	9807 NW 80TH AVE UNIT 11F
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2325
Country	:	US
Telephone Number	:	305-362-9522
Fax Number	:

Provider Business Practice Location Address
First Line	:	9807 NW 80TH AVE UNIT 11F
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2325
Country	:	US
Telephone Number	:	305-362-9522
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	PAUL GUADAGNO
Credential	:
Telephone Number	:	305-362-9522

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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