Healthcare Provider Details

I. General information

NPI: 1295066710
Provider Name (Legal Business Name): OCALA NATURAL MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 SE 23RD AVE
OCALA FL
34471-0710
US

IV. Provider business mailing address

2721 SE 23RD AVE
OCALA FL
34471-0710
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-9998
  • Fax: 352-867-1015
Mailing address:
  • Phone: 352-414-9998
  • Fax: 352-867-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH4801
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH 4801
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN ANDREW PODLASKI
Title or Position: OWNER
Credential: D.C. DABCI,DACBN,CNS
Phone: 352-414-9998