Provider Demographics
NPI: | 1811310048 |
---|---|
Name: | CARPE DIEM CHIROPRACTIC INC |
Entity type: | Organization |
Organization Name: | CARPE DIEM CHIROPRACTIC INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIROPRACTIC |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BARAK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MERAZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 516-395-4882 |
Mailing Address - Street 1: | 1321 S ANDREWS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33316-1837 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 516-395-4882 |
Mailing Address - Fax: | 954-467-1907 |
Practice Address - Street 1: | 1925 CORDOVA RD |
Practice Address - Street 2: | |
Practice Address - City: | FORT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33316-2157 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-980-5483 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-01-23 |
Last Update Date: | 2019-05-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | CH11069 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |