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General NPI Number Information
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NPI Number | 1649689407
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Entity Type | Organization
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Legal Business Name | IBANEZ CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 11601 BISCAYNE BLVD SUITE 306
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City | MIAMI
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State | FL
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Zip | 33181-3151
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Country | US
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Telephone | 305-600-9863
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Fax | 786-332-4065
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Provider Business Mailing Address
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Address Line | 11601 BISCAYNE BLVD SUITE 306
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City | MIAMI
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State | FL
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Zip | 33181-3151
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Country | US
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Telephone | 305-600-9863
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Fax | 786-332-4065
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN IBANEZ
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Credential | DC
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Telephone | 305-600-9863
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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 | CH11143
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License Number State | FL
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