Provider Demographics
NPI:1609509520
Name:JIREH PROVISIONS FL I
Entity Type:Organization
Organization Name:JIREH PROVISIONS FL I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:CAPELOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-680-8182
Mailing Address - Street 1:11011 SHERIDAN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1531
Mailing Address - Country:US
Mailing Address - Phone:954-680-8182
Mailing Address - Fax:
Practice Address - Street 1:11011 SHERIDAN ST STE 214
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1531
Practice Address - Country:US
Practice Address - Phone:954-680-8182
Practice Address - Fax:954-680-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty