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General NPI Number Information
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NPI Number | 1902394778
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Entity Type | Organization
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Legal Business Name | ALIGN TO SHINE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 1633 N HIATUS RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-2129
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Country | US
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Telephone | 754-281-2443
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 266544
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City | WESTON
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State | FL
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Zip | 33326-6544
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Country | US
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Telephone | 754-281-2443
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Fax |
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Authorized Official
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Title or Position | PD
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Name | DR. RICARDO LUIS BACALLAO
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Credential | DC
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Telephone | 754-281-2443
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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 | FL
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