Healthcare Provider Details

I. General information

NPI: 1073476958
Provider Name (Legal Business Name): TELECHIRO FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10033 SAWGRASS DR W
PONTE VEDRA BEACH FL
32082-3564
US

IV. Provider business mailing address

PO BOX 2
LUDOWICI GA
31316-0002
US

V. Phone/Fax

Practice location:
  • Phone: 813-553-2269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRANDEN RACE
Title or Position: OWNER
Credential: DC
Phone: 813-553-2269