Provider Demographics
NPI:1457524787
Name:LLERA, CORA BOOMER (DC)
Entity Type:Individual
Prefix:DR
First Name:CORA
Middle Name:BOOMER
Last Name:LLERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 SABAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2524
Mailing Address - Country:US
Mailing Address - Phone:305-672-2998
Mailing Address - Fax:305-672-7986
Practice Address - Street 1:4014 CHASE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3452
Practice Address - Country:US
Practice Address - Phone:305-672-2998
Practice Address - Fax:305-672-7986
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor