Healthcare Provider Details

I. General information

NPI: 1710196084
Provider Name (Legal Business Name): DAVID MACIVOR D.O.M., A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE SUITE 110
OCOEE FL
34761-4519
US

IV. Provider business mailing address

2582 MAGUIRE RD #324
OCOEE FL
34761-4770
US

V. Phone/Fax

Practice location:
  • Phone: 407-616-1908
  • Fax:
Mailing address:
  • Phone: 407-616-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: