Healthcare Provider Details

I. General information

NPI: 1033599964
Provider Name (Legal Business Name): UCHE UKEAGU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SYBELIA AVE STE 217
MAITLAND FL
32751-4757
US

IV. Provider business mailing address

850 NW 86TH AVE APT 501
PLANTATION FL
33324-1244
US

V. Phone/Fax

Practice location:
  • Phone: 954-415-5931
  • Fax:
Mailing address:
  • Phone: 954-415-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: