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General NPI Number Information
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NPI Number | 1063742468
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS LLC
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 4742 W FLAGLER ST SUT B
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City | CORAL GABLES
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State | FL
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Zip | 33134-1452
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Country | US
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Telephone | 305-877-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 NE 1ST AVE APT 2515
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City | MIAMI
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State | FL
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Zip | 33137-4171
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Country | US
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Telephone | 305-877-5023
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Fax | 305-704-8204
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Authorized Official
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Title or Position | OWNER
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Name | DR. M. CAROLINA RIVAS
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Credential |
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Telephone | 305-877-5023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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