Healthcare Provider Details

I. General information

NPI: 1881875813
Provider Name (Legal Business Name): HOLLYWOOD CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2415 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-6605
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-0250
  • Fax: 954-456-0820
Mailing address:
  • Phone: 954-456-0250
  • Fax: 954-456-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3206
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES MICHAEL STOCK
Title or Position: PRESIDENT
Credential: DC
Phone: 954-922-2553