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General NPI Number Information
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NPI Number | 1295313542
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Entity Type | Individual
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Provider Name | JUSTIN ALEXIS SUJO DC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 13710 SW 84TH ST
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City | MIAMI
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State | FL
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Zip | 33183-4040
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Country | US
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Telephone | 305-385-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 5645 SW 163RD PATH
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City | MIAMI
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State | FL
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Zip | 33193-5643
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Country | US
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Telephone | 305-926-7898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH13312
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License Number State | FL
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