=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811310048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARPE DIEM CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2014
-----------------------------------------------------
Last Update Date | 05/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1925 CORDOVA RD
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-2157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-980-5483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1321 S ANDREWS AVE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-395-4882
-----------------------------------------------------
Fax | 954-467-1907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC
-----------------------------------------------------
Name | DR. BARAK MERAZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 516-395-4882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH11069
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------