Provider Demographics
NPI:1437938776
Name:GD CHIROPRACTIC AND MASSAGE LLC
Entity Type:Organization
Organization Name:GD CHIROPRACTIC AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-301-2393
Mailing Address - Street 1:5400 S WILLIAMSON BLVD APT 2-201
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6531
Mailing Address - Country:US
Mailing Address - Phone:571-426-6061
Mailing Address - Fax:
Practice Address - Street 1:4647 CLYDE MORRIS BLVD UNIT 502
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3001
Practice Address - Country:US
Practice Address - Phone:386-202-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center