Provider Demographics
NPI:1760715817
Name:LOPEZ CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LOPEZ CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-668-8862
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-668-8862
Mailing Address - Fax:305-668-8863
Practice Address - Street 1:4960 SW 72ND AVE STE 304
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5550
Practice Address - Country:US
Practice Address - Phone:305-668-8862
Practice Address - Fax:305-668-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM23209302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization