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General NPI Number Information
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NPI Number | 1518186592
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Entity Type | Organization
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Legal Business Name | MIRACLE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6500 W COLONIAL DR STE D
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City | ORLANDO
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State | FL
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Zip | 32818-7807
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Country | US
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Telephone | 407-296-4848
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Fax | 407-296-4846
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Provider Business Mailing Address
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Address Line | 6500 W COLONIAL DR STE D
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City | ORLANDO
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State | FL
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Zip | 32818-7807
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Country | US
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Telephone | 407-296-4848
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Fax | 407-296-4846
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | MYRLEINE P BRIGNOLE
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Credential | C.C.P.A.
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Telephone | 407-296-4848
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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 | CH2148
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License Number State | FL
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