Healthcare Provider Details

I. General information

NPI: 1245721620
Provider Name (Legal Business Name): FUNCTIONAL HEALTH PLANNING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAIN STREET MVP ATHLETIC CLUB, #237
LADY LAKE FL
32159
US

IV. Provider business mailing address

1000 MAIN STREET MVP ATHLETIC CLUB, #237
LADY LAKE FL
32159
US

V. Phone/Fax

Practice location:
  • Phone: 352-571-5155
  • Fax: 352-633-1396
Mailing address:
  • Phone: 352-571-5155
  • Fax: 352-633-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH10093
License Number StateFL

VIII. Authorized Official

Name: ALEXANDER CHARLES FRANK
Title or Position: OWNER
Credential: DC, DACNB
Phone: 352-571-5155