Provider Demographics
NPI:1134260383
Name:CHIROVISTA MEDICAL INC
Entity type:Organization
Organization Name:CHIROVISTA MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANDREE
Authorized Official - Last Name:LATOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-925-1966
Mailing Address - Street 1:425 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4618
Mailing Address - Country:US
Mailing Address - Phone:954-925-1966
Mailing Address - Fax:
Practice Address - Street 1:425 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4618
Practice Address - Country:US
Practice Address - Phone:954-925-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7446111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty