Healthcare Provider Details

I. General information

NPI: 1245983162
Provider Name (Legal Business Name): DEVYN LEE WIPPERFURTH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 VERSAILLES DR STE 102
MAITLAND FL
32751-7302
US

IV. Provider business mailing address

163 PARSONS RD
LONGWOOD FL
32779-2748
US

V. Phone/Fax

Practice location:
  • Phone: 321-518-5758
  • Fax:
Mailing address:
  • Phone: 407-406-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003276A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: