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General NPI Number Information
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NPI Number | 1134260383
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Entity Type | Organization
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Legal Business Name | CHIROVISTA MEDICAL INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 N FEDERAL HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4618
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Country | US
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Telephone | 954-925-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 425 N FEDERAL HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4618
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Country | US
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Telephone | 954-925-1966
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. MICHELLE ANDREE LATOUCHE
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Credential |
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Telephone | 954-925-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | HCC7446
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License Number State | FL
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