Provider Demographics
NPI:1740618503
Name:JIMENEZ CHIROPRACTIC-MEDSPA, LLC
Entity Type:Organization
Organization Name:JIMENEZ CHIROPRACTIC-MEDSPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JIEMENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-294-0710
Mailing Address - Street 1:2464 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3419
Mailing Address - Country:US
Mailing Address - Phone:786-294-0710
Mailing Address - Fax:786-294-0750
Practice Address - Street 1:2464 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3419
Practice Address - Country:US
Practice Address - Phone:786-294-0710
Practice Address - Fax:786-294-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10366111N00000X, 111N00000X
207R00000X, 207RA0000X
FLPA9100157363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty