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General NPI Number Information
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NPI Number | 1912318841
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Entity Type | Organization
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Legal Business Name | ONE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 3850 BIRD RD SUITE 402B
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City | CORAL GABLES
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State | FL
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Zip | 33146-1501
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Country | US
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Telephone | 305-842-9689
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Fax |
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Provider Business Mailing Address
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Address Line | 17931 NW 52ND AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3103
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Country | US
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Telephone | 386-871-3430
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. COURTNEY L WILSON
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Credential | D.C.
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Telephone | 305-842-9689
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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 | CH11145
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License Number State | FL
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