Healthcare Provider Details

I. General information

NPI: 1376624825
Provider Name (Legal Business Name): ALEX C. ROA-OLMO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX C. ROA D.C.

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE STE 110
OCOEE FL
34761-4519
US

IV. Provider business mailing address

1151 BLACKWOOD AVE STE 110
OCOEE FL
34761-4519
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-8847
  • Fax: 407-930-3544
Mailing address:
  • Phone: 407-205-8847
  • Fax: 407-930-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: