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General NPI Number Information
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NPI Number | 1861697708
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Entity Type | Organization
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Legal Business Name | C&C CHIROPRACTIC AND LASER CENTER
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2250 SW 3RD AVE STE 205
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City | MIAMI
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State | FL
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Zip | 33129-2064
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Country | US
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Telephone | 786-517-6551
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Fax | 786-517-6552
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Provider Business Mailing Address
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Address Line | 2250 SW 3RD AVE STE 205
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City | MIAMI
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State | FL
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Zip | 33129-2064
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Country | US
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Telephone | 786-517-6551
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Fax | 786-517-6552
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ETNA M. CASTELLANOS
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Credential | D.C.
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Telephone | 786-517-6551
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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 | CH7185
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License Number State | FL
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