Healthcare Provider Details

I. General information

NPI: 1982948329
Provider Name (Legal Business Name): M.H.B. LEGACY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W HIGHWAY 50
CLERMONT FL
34711-3027
US

IV. Provider business mailing address

255 W HIGHWAY 50
CLERMONT FL
34711-3027
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-4615
  • Fax: 352-394-7400
Mailing address:
  • Phone: 352-394-4615
  • Fax: 352-394-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10649
License Number StateFL

VIII. Authorized Official

Name: DR. LARHONHDA FARMER
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 678-756-4859