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General NPI Number Information
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NPI Number | 1841124781
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Entity Type | Organization
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Legal Business Name | ICONICO CHIROPRACTIC INC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 2342 WILLET PL APT 4320
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City | MELBOURNE
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State | FL
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Zip | 32940-3626
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Country | US
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Telephone | 305-321-4509
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Fax |
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Provider Business Mailing Address
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Address Line | 2342 WILLET PL APT 4320
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City | MELBOURNE
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State | FL
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Zip | 32940-3626
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Country | US
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Telephone | 305-321-4509
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUILLERMO ENRIQUE COLUMBIE II
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Credential | DC
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Telephone | 305-321-4509
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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 |
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License Number State |
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