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General NPI Number Information
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NPI Number | 1265634430
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12401 ORANGE DRIVE SUITE 219
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City | DAVIE
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State | FL
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Zip | 33330
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Country | US
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Telephone | 954-862-1430
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Fax |
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Provider Business Mailing Address
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Address Line | 10837 GARDEN RIDGE CT
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City | DAVIE
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State | FL
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Zip | 33328-7304
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Country | US
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Telephone | 954-382-3824
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COURTNEE PINGARO
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Credential | DC
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Telephone | 954-862-1430
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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 | 9203
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License Number State | FL
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