Prism Chiropractic and Wellness Center, L.L.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

Legal business name

PRISM CHIROPRACTIC AND WELLNESS CENTER, L.L.C.

Practice address

2250 SW 71St Ter
Davie, FL 33317-7136

Phone

(305) 450-7739

NPI assigned

Jun 17, 2024

Last updated

Jun 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Parker Clive Dominique, DCNPI 1922494509

Title

President/ Ceo

Phone

(305) 450-7739

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Parker Dominique

  • Sports Physician Chiropractor
  • Davie, FL
  • NPI 1922494509
  NPD Authorized official

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1881437978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 SW 71ST TER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333177136",
            "telephone_number": "305-450-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 SW 71ST TER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333177136",
            "telephone_number": "305-450-7739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3117 Bird Ave",
            "address_purpose": "LOCATION",
            "city": "Coconut Grove",
            "state": "FL",
            "postal_code": "331334427",
            "country_code": "US",
            "telephone_number": "305-450-7739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRISM CHIROPRACTIC AND WELLNESS CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "DOMINIQUE",
        "authorized_official_first_name": "PARKER",
        "authorized_official_middle_name": "CLIVE",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "305-450-7739",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Davie, FL
• Providers in Davie, FL by specialty
• Sports Physician Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.