=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144574898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIXTO ALFONSO JR, D.C., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2012
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8660 W FLAGLER ST STE 215
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-6845
-----------------------------------------------------
Fax | 305-228-4432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8660 W FLAGLER ST STE 215
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-6845
-----------------------------------------------------
Fax | 305-228-4432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CALIXTO ALFONSO JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 305-228-6845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH-6680
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------