MEDICARE: EUREKA CHIROPRACTIC CENTER, 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	9867	FL

General Provider Information

NPI Number	:	1780998534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUREKA CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	361 NE 180TH DR
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1768
Country	:	US
Telephone Number	:	305-450-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 NE 180TH DR
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1768
Country	:	US
Telephone Number	:	305-450-7015
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DICKENSON JEANPIERRE
Credential	:	D.C
Telephone Number	:	305-450-7015

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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