MEDICARE: EXCELLENT CARE CHIROPRACTIC CENTER, INC

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	261QM1300X	Multi-Specialty Clinic/Center	HCC5125	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC5125	OTHER	FL	HEALTH CARE CLINIC

General Provider Information

NPI Number	:	1396783361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT CARE CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	6595 NW 36TH ST
Second Line	:	SUITE 304 2
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6979
Country	:	US
Telephone Number	:	305-871-9087
Fax Number	:	305-871-9097

Provider Business Practice Location Address
First Line	:	6595 NW 36TH ST
Second Line	:	SUITE 304 2
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6979
Country	:	US
Telephone Number	:	305-871-9087
Fax Number	:	305-871-9097

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ORLAIDA SIMON
Credential	:
Telephone Number	:	305-871-9087

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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