MEDICARE: TAMARAC CHIROPRACTIC & MEDICAL CENTER 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1104715804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARAC CHIROPRACTIC & MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	5463 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:	954-306-3166
Fax Number	:	954-306-3162

Provider Business Practice Location Address
First Line	:	5463 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:	954-306-3166
Fax Number	:	954-306-3162

Authorized Official
Title or Position	:	OWMER
Name	:	DAVID JAMES KIDD
Credential	:	MD
Telephone Number	:	754-246-2012

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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