Provider Demographics
NPI:1104715804
Name:TAMARAC CHIROPRACTIC & MEDICAL CENTER LLC
Entity type:Organization
Organization Name:TAMARAC CHIROPRACTIC & MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-246-2012
Mailing Address - Street 1:5463 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2954
Mailing Address - Country:US
Mailing Address - Phone:954-306-3166
Mailing Address - Fax:954-306-3162
Practice Address - Street 1:5463 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2954
Practice Address - Country:US
Practice Address - Phone:954-306-3166
Practice Address - Fax:954-306-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center