Provider Demographics
NPI:1700359759
Name:PURA VIDA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PURA VIDA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SCHULTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-220-6778
Mailing Address - Street 1:3959 S NOVA RD STE 9
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4900
Mailing Address - Country:US
Mailing Address - Phone:727-220-6778
Mailing Address - Fax:386-761-2522
Practice Address - Street 1:3959 S NOVA RD STE 9
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4900
Practice Address - Country:US
Practice Address - Phone:727-220-6778
Practice Address - Fax:386-761-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty