Provider Demographics
NPI:1497896278
Name:CHIRO MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:CHIRO MEDICAL CLINIC, INC.
Other - Org Name:C M DIAGNOSTIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-396-9943
Mailing Address - Street 1:4021 N ANDREWS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5297
Mailing Address - Country:US
Mailing Address - Phone:954-396-9943
Mailing Address - Fax:954-630-3359
Practice Address - Street 1:4021 N ANDREWS AVE STE 6
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5297
Practice Address - Country:US
Practice Address - Phone:954-396-9943
Practice Address - Fax:954-630-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty