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General NPI Number Information
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NPI Number | 1811059637
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Entity Type | Organization
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Legal Business Name | PEARL FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1457 N US HIGHWAY 1 SUITE 21
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City | ORMOND BEACH
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State | FL
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Zip | 32174-0702
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Country | US
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Telephone | 386-673-5952
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Fax | 386-673-5953
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Provider Business Mailing Address
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Address Line | 1457 N US HIGHWAY 1 SUITE 21
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City | ORMOND BEACH
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State | FL
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Zip | 32174-0702
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Country | US
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Telephone | 386-673-5952
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Fax | 386-673-5953
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Authorized Official
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Title or Position | OFFICE MANAGER, VICE PRESIDENT
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Name | MS. REBECCA NICHOLAS
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Credential |
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Telephone | 386-673-5952
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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 | CH8810
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License Number State | FL
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