Healthcare Provider Details

I. General information

NPI: 1710259247
Provider Name (Legal Business Name): CHIROMEDIC SERVICES OF N.M.B, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16932 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-3110
US

IV. Provider business mailing address

16932 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-3110
US

V. Phone/Fax

Practice location:
  • Phone: 786-201-2778
  • Fax:
Mailing address:
  • Phone: 786-201-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9004
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL L GUADAGNO
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 786-657-3242