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General NPI Number Information
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NPI Number | 1831553403
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Entity Type | Organization
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Legal Business Name | MOTION IS LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 4476 LEGENDARY DR SUITE 202
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City | DESTIN
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State | FL
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Zip | 32541-5375
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Country | US
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Telephone | 850-974-4842
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Fax |
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Provider Business Mailing Address
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Address Line | 863 SOLIMAR WAY
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City | MARY ESTHER
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State | FL
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Zip | 32569-1421
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Country | US
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Telephone | 850-797-8144
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MELISSA MCKINNEY
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Credential | DC
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Telephone | 850-797-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | CH 11812
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CH 11812
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | CH 11812
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 11812
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License Number State | FL
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