PT Malabar Chiropractic Clinic Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

CH5772 Issued in FL

Legal business name

PT MALABAR CHIROPRACTIC CLINIC INC

Doing business as

Port Malabar Chiropractic

Practice address

5201 Babcock St NE Ste 1
Palm Bay, FL 32905-4637

Phone

(321) 725-5200

Fax

(321) 725-8770

NPI assigned

Aug 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John W Roberts, D.C.

Title

President

Phone

(321) 725-5200

Specialties & licenses 1

Addresses

Other names 1

• Port Malabar Chiropractic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1699968792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 BABCOCK ST NE STE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329054637",
            "telephone_number": "321-725-5200",
            "fax_number": "321-725-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 BABCOCK ST NE STE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329054637",
            "telephone_number": "321-725-5200",
            "fax_number": "321-725-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT MALABAR CHIROPRACTIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-725-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "CH5772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Malabar Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.