Healthcare Provider Details

I. General information

NPI: 1649798224
Provider Name (Legal Business Name): CHIROMEDIC FAMILY PRACTICE OF KENDALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 SW 129TH CT STE 102
MIAMI FL
33186-4582
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 786-429-1937
  • Fax: 786-429-3274
Mailing address:
  • Phone: 17863529327
  • Fax: 305-971-8222

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: ADMINISTRATOR
Credential: DC
Phone: 786-429-1937