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General NPI Number Information
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NPI Number | 1235906702
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Entity Type | Organization
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Legal Business Name | THERAPRACTIC SERVICES
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 4670 NW 183RD ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3054
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Country | US
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Telephone | 786-520-3515
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Fax | 786-551-2275
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Provider Business Mailing Address
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Address Line | 4670 NW 183RD ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3054
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Country | US
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Telephone | 786-520-3515
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Fax | 786-551-2275
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES ROBERTS III
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Credential | DC
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Telephone | 786-520-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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