Provider Demographics
NPI:1821122193
Name:PARDAVE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:PARDAVE CHIROPRACTIC, P.A.
Other - Org Name:JULIO PARDAVE JR., D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:PARDAVE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:305-935-9599
Mailing Address - Street 1:20754 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1146
Mailing Address - Country:US
Mailing Address - Phone:305-935-9599
Mailing Address - Fax:305-932-5612
Practice Address - Street 1:20754 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1146
Practice Address - Country:US
Practice Address - Phone:305-935-9599
Practice Address - Fax:305-932-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205854890OtherINDIVIDUAL TYPE 1 NPI #
FL76028OtherBLUE CROSS BLUE SHIELD
FL=========OtherEIN
FL76028OtherBLUE CROSS BLUE SHIELD