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General NPI Number Information
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NPI Number | 1710909841
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Entity Type | Organization
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Legal Business Name | MEDICHIRO PA
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3391 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3606
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Country | US
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Telephone | 954-696-8141
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Fax | 954-779-3457
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Provider Business Mailing Address
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Address Line | 1228 N VICTORIA PARK RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2418
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Country | US
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Telephone | 954-696-8141
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Fax | 954-779-3457
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Authorized Official
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Title or Position | C.E.O
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Name | DR. FRANK PETER DIBLASE
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Credential | D.C
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Telephone | 954-696-8141
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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 | CH8577
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License Number State | FL
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