Provider Demographics
NPI:1003045055
Name:MIAMI ACCIDENT CLINIC, INC
Entity type:Organization
Organization Name:MIAMI ACCIDENT CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-380-6652
Mailing Address - Street 1:PO BOX 430746
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0746
Mailing Address - Country:US
Mailing Address - Phone:786-380-6652
Mailing Address - Fax:305-441-2509
Practice Address - Street 1:3727 SW 8TH ST STE 102
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3158
Practice Address - Country:US
Practice Address - Phone:786-380-6652
Practice Address - Fax:305-441-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382305900Medicaid
FL3980201900Medicaid
FL382305900Medicaid