Provider Demographics
NPI:1356778658
Name:CHIROPRACTIC USA
Entity type:Organization
Organization Name:CHIROPRACTIC USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MALAVENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-443-1103
Mailing Address - Street 1:PO BOX 420127
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33242-0127
Mailing Address - Country:US
Mailing Address - Phone:305-443-1103
Mailing Address - Fax:305-443-2640
Practice Address - Street 1:2150 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7318
Practice Address - Country:US
Practice Address - Phone:305-443-1103
Practice Address - Fax:786-391-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5656111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050238300Medicaid
FLT85297Medicare UPIN
FL22073ZMedicare PIN