Healthcare Provider Details

I. General information

NPI: 1154186773
Provider Name (Legal Business Name): CHIROPRACTOR BY THE SEA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 MARTINIQUE CT APT D4
COCONUT CREEK FL
33066-1425
US

IV. Provider business mailing address

4402 MARTINIQUE CT APT D4
COCONUT CREEK FL
33066-1425
US

V. Phone/Fax

Practice location:
  • Phone: 561-667-6237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD HEIBA
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-667-6237