Provider Demographics
NPI:1063631703
Name:CHIROMEDIC MOBILE DIAGNOSTIC INC.
Entity Type:Organization
Organization Name:CHIROMEDIC MOBILE DIAGNOSTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUADAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-9522
Mailing Address - Street 1:9807 NW 80TH AVE UNIT 11F
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2325
Mailing Address - Country:US
Mailing Address - Phone:305-362-9522
Mailing Address - Fax:
Practice Address - Street 1:9807 NW 80TH AVE UNIT 11F
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2325
Practice Address - Country:US
Practice Address - Phone:305-362-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile