MEDICARE: SOMA CHIROPRACTIC PC

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	:	1699415844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	5600 BOVINE DR APT 9107
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-0047
Country	:	US
Telephone Number	:	787-236-7917
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 BOVINE DR APT 9107
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-0047
Country	:	US
Telephone Number	:	787-236-7917
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	CID MARIE CORREA
Credential	:
Telephone Number	:	787-236-7917

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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