Provider Demographics
NPI:1558671545
Name:BONE ISLAND CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BONE ISLAND CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MUNOZ-KOKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-296-2663
Mailing Address - Street 1:3201 FLAGLER AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4693
Mailing Address - Country:US
Mailing Address - Phone:305-296-2663
Mailing Address - Fax:305-296-2668
Practice Address - Street 1:3201 FLAGLER AVE STE 509
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4693
Practice Address - Country:US
Practice Address - Phone:305-296-2663
Practice Address - Fax:305-296-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO6748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002822900Medicaid