Healthcare Provider Details

I. General information

NPI: 1497527055
Provider Name (Legal Business Name): HEALTHY FAMILY CHIROPRACTIC CLINIC L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 BABCOCK ST NE
PALM BAY FL
32905-4612
US

IV. Provider business mailing address

5200 BABCOCK ST NE STE 400A
PALM BAY FL
32905-4612
US

V. Phone/Fax

Practice location:
  • Phone: 321-328-0086
  • Fax:
Mailing address:
  • Phone: 321-328-0086
  • Fax:

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: BETHE RUEDE
Title or Position: OWNER
Credential: DC
Phone: 321-328-0086