Provider Demographics
NPI:1710259247
Name:CHIROMEDIC SERVICES OF N.M.B, INC
Entity Type:Organization
Organization Name:CHIROMEDIC SERVICES OF N.M.B, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUADAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-657-3242
Mailing Address - Street 1:16932 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3110
Mailing Address - Country:US
Mailing Address - Phone:786-201-2778
Mailing Address - Fax:
Practice Address - Street 1:16932 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3110
Practice Address - Country:US
Practice Address - Phone:786-201-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9004111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45-4256076OtherEIN