Provider Demographics
NPI:1558651489
Name:KENDALL CHIRO, LLC
Entity Type:Organization
Organization Name:KENDALL CHIRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:HAPUC
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-761-6528
Mailing Address - Street 1:PO BOX 4533
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-0533
Mailing Address - Country:US
Mailing Address - Phone:305-761-6528
Mailing Address - Fax:305-675-0863
Practice Address - Street 1:13501 SW 136TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8319
Practice Address - Country:US
Practice Address - Phone:305-761-6528
Practice Address - Fax:305-675-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9468273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit