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General NPI Number Information
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NPI Number | 1689188005
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Entity Type | Organization
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Legal Business Name | GO CHIRO ACCIDENT AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 1840 FOREST HILL BLVD STE 201
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City | LAKE CLARKE SHORES
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State | FL
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Zip | 33406-6059
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Country | US
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Telephone | 561-847-4025
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Fax | 561-847-4038
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Provider Business Mailing Address
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Address Line | 1840 FOREST HILL BLVD STE 201
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City | LAKE CLARKE SHORES
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State | FL
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Zip | 33406-6059
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Country | US
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Telephone | 561-847-4025
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Fax | 561-847-4038
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | LUKAS CORREA
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Credential |
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Telephone | 561-847-4025
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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 | CH10362
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License Number State | FL
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