Healthcare Provider Details

I. General information

NPI: 1164709812
Provider Name (Legal Business Name): EAST COLONIAL CHIROPRACTIC OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 UNIVERSITY BLVD SUITE 103
ORLANDO FL
32817-2197
US

IV. Provider business mailing address

11500 UNIVERSITY BLVD SUITE 103
ORLANDO FL
32817-2197
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-6500
  • Fax: 407-277-2690
Mailing address:
  • Phone: 407-658-6500
  • Fax: 407-277-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH0006110
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES BOWLES
Title or Position: OWNER
Credential: D.C.
Phone: 407-658-6500