MEDICARE: JIMENEZ CHIROPRACTIC-MEDSPA, 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	CH10366	FL
2	363AM0700X	Medical Physician Assistant	PA9100157	FL
3	207R00000X	Internal Medicine Physician
4	207RA0000X	Adolescent Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1740618503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMENEZ CHIROPRACTIC-MEDSPA, LLC

Provider Business Mailing Address
First Line	:	2464 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3419
Country	:	US
Telephone Number	:	786-294-0710
Fax Number	:	786-294-0750

Provider Business Practice Location Address
First Line	:	2464 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3419
Country	:	US
Telephone Number	:	786-294-0710
Fax Number	:	786-294-0750

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAYKEL JIEMENZ
Credential	:	DC
Telephone Number	:	786-294-0710

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	05/21/2015

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