Healthcare Provider Details

I. General information

NPI: 1841755907
Provider Name (Legal Business Name): COCOA CHIROPRACTIC CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2128
US

IV. Provider business mailing address

984 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2128
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-6090
  • Fax: 321-632-5805
Mailing address:
  • Phone: 321-636-6090
  • Fax: 321-632-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANDREW R CANAVAN
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 321-636-6090