Provider Demographics
NPI:1902394778
Name:ALIGN TO SHINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALIGN TO SHINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BACALLAO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:754-281-2443
Mailing Address - Street 1:PO BOX 266544
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-6544
Mailing Address - Country:US
Mailing Address - Phone:754-281-2443
Mailing Address - Fax:
Practice Address - Street 1:1633 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2129
Practice Address - Country:US
Practice Address - Phone:754-281-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty