Healthcare Provider Details

I. General information

NPI: 1720282643
Provider Name (Legal Business Name): SHAMEKA VIVRE MIXON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NW 36TH ST SUITE 387
VIRGINIA GARDENS FL
33166-6959
US

IV. Provider business mailing address

1814 ECHO LAKE DR
WEST PALM BEACH FL
33407-3567
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-0941
  • Fax: 305-871-0942
Mailing address:
  • Phone: 561-842-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: