MEDICARE: CHIROPRACTIC WELLNESS CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1053570945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC WELLNESS CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	1580 SHORELINE WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-5010
Country	:	US
Telephone Number	:	954-456-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 SHORELINE WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-5010
Country	:	US
Telephone Number	:	954-589-8359
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OLGA SPIVAK
Credential	:	D.C.
Telephone Number	:	954-589-8359

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	07/09/2013

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