MEDICARE: ILEAN M SANTOS COLON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH11731	FL

General Provider Information

NPI Number	:	1801251301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEAN M SANTOS COLON D.C.

Provider Business Mailing Address
First Line	:	857 WOODBURY RD STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4505
Country	:	US
Telephone Number	:	407-440-0026
Fax Number	:	407-440-0027

Provider Business Practice Location Address
First Line	:	857 WOODBURY RD STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4505
Country	:	US
Telephone Number	:	407-440-0026
Fax Number	:	407-440-0027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	04/03/2023

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