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General NPI Number Information
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NPI Number | 1568883536
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC CENTER, LLC
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 3915 BISCAYNE BLVD STE 406
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City | MIAMI
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State | FL
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Zip | 33137-3737
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Country | US
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Telephone | 305-367-1176
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Fax | 877-391-0039
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Provider Business Mailing Address
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Address Line | 3915 BISCAYNE BLVD STE 406
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City | MIAMI
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State | FL
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Zip | 33137-3737
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Country | US
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Telephone | 305-367-1176
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Fax | 877-391-0039
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Authorized Official
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Title or Position | MGRM
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Name | KRISTOPHER SEAN GODDARD
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Credential | D.O.
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Telephone | 305-367-1176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1037
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS10979
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License Number State | FL
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