Healthcare Provider Details

I. General information

NPI: 1659713402
Provider Name (Legal Business Name): HSS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 SE FEDERAL HWY SUITE 104
STUART FL
34997-5760
US

IV. Provider business mailing address

4401 SE FEDERAL HWY SUITE 104
STUART FL
34997-5760
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1720
  • Fax: 772-286-7141
Mailing address:
  • Phone: 772-286-1720
  • Fax: 772-286-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALYSSA KENYON
Title or Position: CEO
Credential: DC
Phone: 772-286-1720