=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972621324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL CHIROPRACTIC CARE CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 04/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8025 BISCAYNE BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-4620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-758-9550
-----------------------------------------------------
Fax | 305-758-9430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8025 BISCAYNE BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-4620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-758-9550
-----------------------------------------------------
Fax | 305-758-9430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OWNER
-----------------------------------------------------
Name | DR. GORDON JAY FRANKEL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 305-758-9550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | CH5778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------