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General NPI Number Information
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NPI Number | 1265581573
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Entity Type | Organization
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Legal Business Name | ACOSTA CHIROPRACTIC CENTER CORP
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 SW 107TH AVE UNIT 4
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City | MIAMI
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State | FL
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Zip | 33174-1415
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Country | US
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Telephone | 305-480-5900
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Fax | 305-489-5911
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Provider Business Mailing Address
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Address Line | 7 SW 107TH AVE UNIT 4
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City | MIAMI
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State | FL
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Zip | 33174-1415
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Country | US
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Telephone | 305-480-5900
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Fax | 305-489-5911
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Authorized Official
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Title or Position | OWNER
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Name | MR. GUSTAVO ACOSTA
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Credential | DC
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Telephone | 305-480-5900
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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 | CH8885
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License Number State | FL
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