# ADVANCED MEDICAL DIAMOND GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619304573
- **Authorized official:** DANIEL CHARLESTON D.C. (OWNER)
- **Authorized official phone:** (561) 278-9005

## Contact information

- **Practice address:** 1055 S CONGRESS AVE, SUITE 1, DELRAY BEACH, FL 33445-6001
- **Practice address phone:** (561) 278-9005
- **Practice address fax:** (561) 423-0800
- **Mailing address:** 1055 S CONGRESS AVE, SUITE 1, DELRAY BEACH, FL 33445-6001
- **Mailing address phone:** (561) 278-9005
- **Mailing address fax:** (561) 423-0800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CH8492 | FL | — |
| 207Q00000X | Family Medicine Physician | ME113665 | FL | Yes |

## Other

- **Enumeration date:** 10/08/2013
- **Last updated:** 10/08/2013