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General NPI Number Information
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NPI Number | 1982051173
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Entity Type | Organization
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Legal Business Name | VIDA CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 3420 W 84TH ST STE 102
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City | HIALEAH
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State | FL
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Zip | 33018-4937
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Country | US
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Telephone | 305-603-8408
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Fax | 305-603-8906
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Provider Business Mailing Address
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Address Line | 3420 W 84TH ST STE 102
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City | HIALEAH
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State | FL
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Zip | 33018-4937
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Country | US
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Telephone | 305-603-8408
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Fax | 305-603-8906
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. DANAY S GONZALEZ
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Credential | DC
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Telephone | 786-247-2010
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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 | CH10619
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10589
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License Number State | FL
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