Provider Demographics
NPI:1588312987
Name:100 CHIRO MALPICA LLC
Entity type:Organization
Organization Name:100 CHIRO MALPICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALPICA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-247-5380
Mailing Address - Street 1:2221 NW FEDERAL HWY APT 2448
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9491
Mailing Address - Country:US
Mailing Address - Phone:561-566-0447
Mailing Address - Fax:
Practice Address - Street 1:11360 LEGACY AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3663
Practice Address - Country:US
Practice Address - Phone:561-247-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty