MEDICARE: 100 CHIRO BEVIS NUTTY, 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	:	1194441592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	100 CHIRO BEVIS NUTTY, LLC

Provider Business Mailing Address
First Line	:	8570 STIRLING RD STE 103
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8204
Country	:	US
Telephone Number	:	954-743-4133
Fax Number	:

Provider Business Practice Location Address
First Line	:	8570 STIRLING RD STE 103
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8204
Country	:	US
Telephone Number	:	954-743-4133
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN NUTTY
Credential	:
Telephone Number	:	315-525-8770

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	07/24/2024

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