Healthcare Provider Details

I. General information

NPI: 1285133538
Provider Name (Legal Business Name): CHIROMEDIC HEALTHCARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 SW 72ND STREET SUITE 203
MIAMI FL
33143-3314
US

IV. Provider business mailing address

6075 SW 72ND ST STE 203
SOUTH MIAMI FL
33143-5000
US

V. Phone/Fax

Practice location:
  • Phone: 305-971-0302
  • Fax: 305-971-8222
Mailing address:
  • Phone: 305-971-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9004
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL L GUADAGNO
Title or Position: OWNER
Credential: DC
Phone: 305-971-0302