Healthcare Provider Details

I. General information

NPI: 1689902199
Provider Name (Legal Business Name): MACDERMOTT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 MALLORY CIR STE 205
KISSIMMEE FL
34747-1818
US

IV. Provider business mailing address

2940 MALLORY CIR STE 205
KISSIMMEE FL
34747-1818
US

V. Phone/Fax

Practice location:
  • Phone: 407-507-6976
  • Fax:
Mailing address:
  • Phone: 407-507-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEREMY GOOD
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 843-697-6994