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General NPI Number Information
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NPI Number | 1669624763
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Entity Type | Organization
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Legal Business Name | PAGE CHIROPRACTIC LIFE CENTER P A
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 6705 S RED RD STE 702
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3649
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Country | US
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Telephone | 305-662-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 6705 S RED RD STE 702
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3649
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Country | US
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Telephone | 305-662-6433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND C PAGE
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Credential | DC
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Telephone | 305-662-6433
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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 | CH7080
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License Number State | FL
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