Healthcare Provider Details

I. General information

NPI: 1871697862
Provider Name (Legal Business Name): AMIT A PATEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 FORTENBERRY RD
MERRITT ISLAND FL
32952-3616
US

IV. Provider business mailing address

80 FORTENBERRY RD
MERRITT ISLAND FL
32952-3616
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-1345
  • Fax: 321-453-3131
Mailing address:
  • Phone: 321-453-1345
  • Fax: 321-453-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: