Healthcare Provider Details

I. General information

NPI: 1992370803
Provider Name (Legal Business Name): MEDA-PEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11451 SW 43RD DR APT 7203
MIRAMAR FL
33025-8042
US

IV. Provider business mailing address

11451 SW 43RD DR APT 7203
MIRAMAR FL
33025-8042
US

V. Phone/Fax

Practice location:
  • Phone: 305-609-4902
  • Fax:
Mailing address:
  • Phone: 305-609-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN R COLEMAN
Title or Position: PROVIDER
Credential: DC
Phone: 305-609-4902