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General NPI Number Information
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NPI Number | 1588318133
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Entity Type | Organization
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Legal Business Name | NEW VIDA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 6607 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3526
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Country | US
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Telephone | 561-733-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 NW 44TH ST APT 107
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33309-4262
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Country | US
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Telephone | 305-282-6396
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | NAYARA D MIRANDA
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Credential | DC
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Telephone | 305-282-6396
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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 |
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License Number State |
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