MEDICARE: CHIROCARE OF WESTON, 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		FL

General Provider Information

NPI Number	:	1669835625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROCARE OF WESTON, LLC

Provider Business Mailing Address
First Line	:	18205 BISCAYNE BLVD STE 2214
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33160-2148
Country	:	US
Telephone Number	:	305-705-3775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2853 EXECUTIVE PARK DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3656
Country	:	US
Telephone Number	:	305-932-2202
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDREW SANDS
Credential	:
Telephone Number	:	305-705-3775

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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