Healthcare Provider Details

I. General information

NPI: 1205513322
Provider Name (Legal Business Name): MYCHIRO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8763 RIVER CROSSING BLVD
NEW PORT RICHEY FL
34655-1112
US

IV. Provider business mailing address

491 MARINER BLVD
SPRING HILL FL
34609-5680
US

V. Phone/Fax

Practice location:
  • Phone: 135-251-5600
  • Fax: 352-610-4387
Mailing address:
  • Phone: 352-515-6000
  • Fax: 352-610-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACY WALKE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 352-515-6000