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NPI Code Detail

MEDICARE: GO CHIRO ACCIDENT AND WELLNESS CENTER LLC

MEDICARE: GO CHIRO ACCIDENT AND WELLNESS CENTER LLC
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
1111N00000XChiropractorCH10362FL

General Provider Information

NPI Number : 1689188005
Entity Type Code : Organization
Provider Name (Legal Business Name) : GO CHIRO ACCIDENT AND WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 1840 FOREST HILL BLVD STE 201
Second Line :
City : LAKE CLARKE SHORES
State : FL
Zip : 33406-6059
Country : US
Telephone Number : 561-847-4025
Fax Number : 561-847-4038
Provider Business Practice Location Address
First Line : 1840 FOREST HILL BLVD STE 201
Second Line :
City : LAKE CLARKE SHORES
State : FL
Zip : 33406-6059
Country : US
Telephone Number : 561-847-4025
Fax Number : 561-847-4038
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : LUKAS CORREA
Credential :
Telephone Number : 561-847-4025
Provider Enumeration Date : 11/21/2017
Last Update Date : 11/21/2017

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Directions to “GO CHIRO ACCIDENT AND WELLNESS CENTER LLC ” Practice Location

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