Provider Demographics
NPI:1518186592
Name:MIRACLE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MIRACLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MYRLEINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRIGNOLE
Authorized Official - Suffix:
Authorized Official - Credentials:CCPA
Authorized Official - Phone:407-296-4848
Mailing Address - Street 1:6500 W COLONIAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7807
Mailing Address - Country:US
Mailing Address - Phone:407-296-4848
Mailing Address - Fax:407-296-4846
Practice Address - Street 1:6500 W COLONIAL DR STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7807
Practice Address - Country:US
Practice Address - Phone:407-296-4848
Practice Address - Fax:407-296-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69874AMedicare ID - Type UnspecifiedMEDICARE
FLT85547Medicare UPIN