Provider Demographics
NPI:1235336058
Name:CHARLOTTE GARZON
Entity Type:Organization
Organization Name:CHARLOTTE GARZON
Other - Org Name:DORAL CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ARLETT
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-463-9697
Mailing Address - Street 1:2406 NORTH WEST 87 PLACE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1201
Mailing Address - Country:US
Mailing Address - Phone:305-463-9697
Mailing Address - Fax:305-463-9699
Practice Address - Street 1:2406 NORTH WEST 87 PLACE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1201
Practice Address - Country:US
Practice Address - Phone:305-463-9697
Practice Address - Fax:305-463-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382159500Medicaid
FLU99187Medicare UPIN