Provider Demographics
NPI:1639477813
Name:METAMORPHOSIZE CHIROPRACTIC
Entity Type:Organization
Organization Name:METAMORPHOSIZE CHIROPRACTIC
Other - Org Name:SOUTH FLORIDA THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-605-2737
Mailing Address - Street 1:919 E CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4116
Mailing Address - Country:US
Mailing Address - Phone:954-605-2737
Mailing Address - Fax:954-349-8672
Practice Address - Street 1:919 E CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4116
Practice Address - Country:US
Practice Address - Phone:954-605-2737
Practice Address - Fax:954-349-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty