| Gd Chiropractic And Massage Llc | |
|
4647 Clyde Morris Blvd Unit 502 Port Orange FL 32129-3001 | |
| (386) 202-2714 | |
| Not Available |
| Full Name | Gd Chiropractic And Massage Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4647 Clyde Morris Blvd Unit 502, Port Orange, Florida |
| Authorized Official Name and Position | Georgi S Dimov (CHIROPRACTIC PHYSICIAN) |
| Authorized Official Contact | 3863012393 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gd Chiropractic And Massage Llc 5400 S Williamson Blvd Apt 2-201 Port Orange FL 32128-6531 Ph: (571) 426-6061 | Gd Chiropractic And Massage Llc 4647 Clyde Morris Blvd Unit 502 Port Orange FL 32129-3001 Ph: (386) 202-2714 |
| NPI Number | 1437938776 |
|---|---|
| Provider Enumeration Date | 09/26/2023 |
| Last Update Date | 09/26/2023 |
| Medicare PECOS PAC ID | 0345699518 |
|---|---|
| Medicare Enrollment ID | O20231213001676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437938776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Danielle N Menneto |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1659695583 PECOS PAC ID: 6002081817 Enrollment ID: I20111206000637 |
| Provider Name | Georgi Dimov |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326746777 PECOS PAC ID: 1052760220 Enrollment ID: I20231211000805 |
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