Provider Demographics
NPI:1780076661
Name:MIND, BODY AND SPIRIT CHIROPRACTIC INC.
Entity type:Organization
Organization Name:MIND, BODY AND SPIRIT CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ORTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-655-7300
Mailing Address - Street 1:1314 E LAS OLAS BLVD # 111
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-655-7300
Mailing Address - Fax:954-523-2540
Practice Address - Street 1:755 LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-884-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty