Healthcare Provider Details

I. General information

NPI: 1407222102
Provider Name (Legal Business Name): MIAMI MEDICAL WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 BIRD RD 402B
MIAMI FL
33146-1501
US

IV. Provider business mailing address

3850 BIRD RD 402B
MIAMI FL
33146-1501
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-2600
  • Fax: 305-390-3011
Mailing address:
  • Phone: 305-448-2600
  • Fax: 305-390-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10986
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2395
License Number StateFL

VIII. Authorized Official

Name: DR. RYAN BRADY
Title or Position: OWNER
Credential: D.C.
Phone: 305-448-2600