Provider Demographics
NPI:1497393615
Name:VIDA CHIROPRACTIC MIAMI II CORP
Entity type:Organization
Organization Name:VIDA CHIROPRACTIC MIAMI II CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-701-9207
Mailing Address - Street 1:12484 SW 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6597
Mailing Address - Country:US
Mailing Address - Phone:786-701-9207
Mailing Address - Fax:
Practice Address - Street 1:12484 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6597
Practice Address - Country:US
Practice Address - Phone:786-701-9207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty