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General NPI Number Information
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NPI Number | 1346616190
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Entity Type | Individual
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Provider Name | JACK FAMIGLIO DC, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 9841 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6100
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Country | US
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Telephone | 954-437-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 9841 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6100
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Country | US
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Telephone | 954-309-7954
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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 | CH13768
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATH.200458
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License Number State | LA
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