Provider Demographics
NPI:1063445872
Name:DYNAMIC CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-221-4949
Mailing Address - Street 1:16502 SW 68TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5252
Mailing Address - Country:US
Mailing Address - Phone:305-519-6937
Mailing Address - Fax:305-221-9049
Practice Address - Street 1:14680 SW 8TH ST STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3138
Practice Address - Country:US
Practice Address - Phone:305-221-4949
Practice Address - Fax:305-221-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55878AOtherBCBS