Provider Demographics
NPI:1689119125
Name:AMARA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:AMARA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRIOPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:AMARA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:386-767-2064
Mailing Address - Street 1:2445 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3077
Mailing Address - Country:US
Mailing Address - Phone:386-767-2064
Mailing Address - Fax:386-756-5700
Practice Address - Street 1:2445 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3077
Practice Address - Country:US
Practice Address - Phone:386-767-2064
Practice Address - Fax:386-756-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty