Provider Demographics
NPI:1568868032
Name:MIND, BODY & SPIRIT CHIROPRACTIC
Entity Type:Organization
Organization Name:MIND, BODY & SPIRIT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ORTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-655-7300
Mailing Address - Street 1:150 NE 15TH AVE APT 151
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 E SAMPLE RD
Practice Address - Street 2:BUILDING 10, SUITE 6
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5144
Practice Address - Country:US
Practice Address - Phone:954-655-7300
Practice Address - Fax:954-523-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty