Healthcare Provider Details

I. General information

NPI: 1336495118
Provider Name (Legal Business Name): CORAL CHIROPRACTIC CENTER, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 SW 8TH ST SUITE 213
MIAMI FL
33144-4263
US

IV. Provider business mailing address

8150 SW 8TH ST SUITE 213
MIAMI FL
33144-4263
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-1945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAYAMI SERPA
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-266-1945