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General NPI Number Information
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NPI Number | 1780076661
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Entity Type | Organization
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Legal Business Name | MIND, BODY AND SPIRIT CHIROPRACTIC INC.
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 755 LE JEUNE RD
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City | HIALEAH
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State | FL
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Zip | 33010-4613
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Country | US
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Telephone | 305-884-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 E LAS OLAS BLVD # 111
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2334
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Country | US
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Telephone | 954-655-7300
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Fax | 954-523-2540
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. AMY ELIZABETH ORTA
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Credential | D.C.
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Telephone | 954-655-7300
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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 | CH8205
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License Number State | FL
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