Provider Demographics
NPI:1427370196
Name:GARRETT CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:GARRETT CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIEBERMAN- GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, DC, RYT
Authorized Official - Phone:305-853-1003
Mailing Address - Street 1:90290 OVERSEAS HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2263
Mailing Address - Country:US
Mailing Address - Phone:305-853-1003
Mailing Address - Fax:305-853-0880
Practice Address - Street 1:90290 OVERSEAS HWY STE 110
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2263
Practice Address - Country:US
Practice Address - Phone:305-853-1003
Practice Address - Fax:305-853-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55237Medicare PIN
U54798Medicare UPIN