MEDICARE: MIRACLE CHIROPRACTIC CLINIC

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	CH2148	FL

General Provider Information

NPI Number	:	1518186592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	6500 W COLONIAL DR STE D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7807
Country	:	US
Telephone Number	:	407-296-4848
Fax Number	:	407-296-4846

Provider Business Practice Location Address
First Line	:	6500 W COLONIAL DR STE D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7807
Country	:	US
Telephone Number	:	407-296-4848
Fax Number	:	407-296-4846

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	MYRLEINE P BRIGNOLE
Credential	:	C.C.P.A.
Telephone Number	:	407-296-4848

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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Directions to “MIRACLE CHIROPRACTIC CLINIC ” Practice Location

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