Provider Demographics
NPI:1689188005
Name:GO CHIRO ACCIDENT AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:GO CHIRO ACCIDENT AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-847-4025
Mailing Address - Street 1:1840 FOREST HILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6059
Mailing Address - Country:US
Mailing Address - Phone:561-847-4025
Mailing Address - Fax:561-847-4038
Practice Address - Street 1:1840 FOREST HILL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6059
Practice Address - Country:US
Practice Address - Phone:561-847-4025
Practice Address - Fax:561-847-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty