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NPI Code Detail

MEDICARE: CHANGING TIDES CHIROPRACTIC & WELLNESS, LLC.

MEDICARE: CHANGING TIDES CHIROPRACTIC & WELLNESS, 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
1111N00000XChiropractor

General Provider Information

NPI Number : 1194290320
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHANGING TIDES CHIROPRACTIC & WELLNESS, LLC.
Provider Business Mailing Address
First Line : 1000 PLANTATION ISLAND DR S STE 9
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32080-3106
Country : US
Telephone Number : 904-217-0715
Fax Number :
Provider Business Practice Location Address
First Line : 1000 PLANTATION ISLAND DR S STE 9
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32080-3106
Country : US
Telephone Number : 904-217-0715
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELIANA MARIA MELENDEZ-SANTIAGO
Credential : D.C.
Telephone Number : 904-217-0715
Provider Enumeration Date : 10/03/2018
Last Update Date : 10/03/2018

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Directions to “CHANGING TIDES CHIROPRACTIC & WELLNESS, LLC. ” Practice Location

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