Healthcare Provider Details

I. General information

NPI: 1154351229
Provider Name (Legal Business Name): HEALTHY HEART CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 S HWY A1A SUITE 4-183
MELBOURNE BEACH FL
32951-3143
US

IV. Provider business mailing address

3830 S HWY A1A SUITE 4-183
MELBOURNE BEACH FL
32951-3143
US

V. Phone/Fax

Practice location:
  • Phone: 321-728-8400
  • Fax:
Mailing address:
  • Phone: 321-728-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS 0004658
License Number StateFL

VIII. Authorized Official

Name: DR. KEVIN B CHAPIN
Title or Position: OWNER
Credential: D.O.
Phone: 321-728-8400