Healthcare Provider Details

I. General information

NPI: 1043997356
Provider Name (Legal Business Name): WORRELL TROUP II D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5822 SW 59TH ST
MIAMI FL
33143-2325
US

IV. Provider business mailing address

5822 SW 59TH ST
MIAMI FL
33143-2325
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-2640
  • Fax:
Mailing address:
  • Phone: 786-853-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH14584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: