Healthcare Provider Details

I. General information

NPI: 1922576743
Provider Name (Legal Business Name): ELITE SPINE MIAMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 SW 128TH CT STE 201
MIAMI FL
33186-4666
US

IV. Provider business mailing address

1336 NW 84TH AVE
DORAL FL
33126-1500
US

V. Phone/Fax

Practice location:
  • Phone: 305-710-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. OSCAR MOLINA
Title or Position: PRESIDENT
Credential: DC
Phone: 305-710-0395