Provider Demographics
NPI:1770388365
Name:ILLUMINNATE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ILLUMINNATE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-231-7033
Mailing Address - Street 1:2655 E OAKLAND PARK BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1608
Mailing Address - Country:US
Mailing Address - Phone:863-231-7033
Mailing Address - Fax:
Practice Address - Street 1:2655 E OAKLAND PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1608
Practice Address - Country:US
Practice Address - Phone:754-280-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty