Provider Demographics
NPI:1649585886
Name:DESTINY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DESTINY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-627-8464
Mailing Address - Street 1:3178 BERMUDA RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2421
Mailing Address - Country:US
Mailing Address - Phone:561-627-8464
Mailing Address - Fax:561-775-5655
Practice Address - Street 1:3365 BURNS RD STE 214
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4312
Practice Address - Country:US
Practice Address - Phone:561-627-8464
Practice Address - Fax:561-627-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5873261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center