Provider Demographics
NPI:1184988297
Name:SOUTH MIAMI CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTH MIAMI CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DL
Authorized Official - Phone:786-433-7344
Mailing Address - Street 1:6075 SW 72ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5000
Mailing Address - Country:US
Mailing Address - Phone:786-433-7344
Mailing Address - Fax:786-433-7345
Practice Address - Street 1:6075 SW 72ND ST STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5000
Practice Address - Country:US
Practice Address - Phone:786-433-7344
Practice Address - Fax:786-433-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty