Healthcare Provider Details

I. General information

NPI: 1295345932
Provider Name (Legal Business Name): HOUSECALLSPINEDOCTOR-COM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W HALLANDALE BEACH BLVD # 346
HALLANDALE BEACH FL
33009-5441
US

IV. Provider business mailing address

221 W HALLANDALE BEACH BLVD # 346
HALLANDALE BEACH FL
33009-5441
US

V. Phone/Fax

Practice location:
  • Phone: 800-315-7611
  • Fax: 305-723-3334
Mailing address:
  • Phone: 800-315-7611
  • Fax: 305-723-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDE ALCIDE
Title or Position: OWNER
Credential: DC
Phone: 800-315-7611