Healthcare Provider Details

I. General information

NPI: 1831553403
Provider Name (Legal Business Name): MOTION IS LIFE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 LEGENDARY DR SUITE 202
DESTIN FL
32541-5375
US

IV. Provider business mailing address

863 SOLIMAR WAY
MARY ESTHER FL
32569-1421
US

V. Phone/Fax

Practice location:
  • Phone: 850-974-4842
  • Fax:
Mailing address:
  • Phone: 850-797-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11812
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH 11812
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH 11812
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH 11812
License Number StateFL

VIII. Authorized Official

Name: MELISSA MCKINNEY
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 850-797-8144