Organization
VITAL WAVE CHIROPRACTIC
Active
Other names
LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH HUMPHRIES DC (OWNER/CHIROPRACTOR)
(954) 884-0704
Entity
Organization
Contact information
Practice address
909 NE 20TH AVE, FORT LAUDERDALE, FL 33304-3037
(954) 884-0704
Mailing address
909 NE 20TH AVE, FORT LAUDERDALE, FL 33304-3037
(954) 884-0704
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CH12216
FL
111NR0400X
Rehabilitation Chiropractor
Primary
CH12216
FL
Other
Enumeration date
06/29/2017
Last updated
07/21/2022
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